WHAT IT TRULY MEANS TO BE UNDETECTABLE BECAUSE YOU’RE MORE THAN YOUR STATUS
EMPIRE STRIKES BACK
STAR JUSSIE SMOLLETT IS THE HIV ACTIVIST WE NEED NOW
HAMILTON STAR JAVIER MUÑOZ COMES OUT POZ WHY MESS IS MUST WATCH GAY TV RESISTANCE 101 HOW TO FIGHT OFF TREATMENT FAILURE
JANUARY/FEBRUARY 2017 www.hivplusmag.com
YOU MATTER AND SO DOES YOUR HEALTH That’s why starting and staying on HIV-1 treatment is so important.
What is DESCOVY ?
What are the other possible side effects of DESCOVY?
DESCOVY is a prescription medicine that is used together with other HIV-1 medicines to treat HIV-1 in people 12 years and older. DESCOVY is not for use to help reduce the risk of getting HIV-1 infection. DESCOVY combines 2 medicines into 1 pill taken once a day. Because DESCOVY by itself is not a complete treatment for HIV-1, it must be used together with other HIV-1 medicines.
Serious side effects of DESCOVY may also include:
®
DESCOVY does not cure HIV-1 infection or AIDS. To control HIV-1 infection and decrease HIV-related illnesses, you must keep taking DESCOVY. Ask your healthcare provider if you have questions about how to reduce the risk of passing HIV-1 to others. Always practice safer sex and use condoms to lower the chance of sexual contact with body fluids. Never reuse or share needles or other items that have body fluids on them.
IMPORTANT SAFETY INFORMATION What is the most important information I should know about DESCOVY? DESCOVY may cause serious side effects: •
•
•
•
Buildup of an acid in your blood (lactic acidosis), which is a serious medical emergency. Symptoms of lactic acidosis include feeling very weak or tired, unusual muscle pain, trouble breathing, stomach pain with nausea or vomiting, feeling cold (especially in your arms and legs), feeling dizzy or lightheaded, and/or a fast or irregular heartbeat. Serious liver problems. The liver may become large and fatty. Symptoms of liver problems include your skin or the white part of your eyes turning yellow (jaundice); dark “tea-colored” urine; light-colored bowel movements (stools); loss of appetite; nausea; and/or pain, aching, or tenderness on the right side of your stomach area. You may be more likely to get lactic acidosis or serious liver problems if you are female, very overweight, or have been taking DESCOVY for a long time. In some cases, lactic acidosis and serious liver problems have led to death. Call your healthcare provider right away if you have any symptoms of these conditions. Worsening of hepatitis B (HBV) infection. DESCOVY is not approved to treat HBV. If you have both HIV-1 and HBV and stop taking DESCOVY, your HBV may suddenly get worse. Do not stop taking DESCOVY without first talking to your healthcare provider, as they will need to monitor your health.
•
Changes in body fat, which can happen in people taking HIV-1 medicines.
•
Changes in your immune system. Your immune system may get stronger and begin to fight infections. Tell your healthcare provider if you have any new symptoms after you start taking DESCOVY.
•
Kidney problems, including kidney failure. Your healthcare provider should do blood and urine tests to check your kidneys. Your healthcare provider may tell you to stop taking DESCOVY if you develop new or worse kidney problems.
•
Bone problems, such as bone pain, softening, or thinning, which may lead to fractures. Your healthcare provider may do tests to check your bones.
The most common side effect of DESCOVY is nausea. Tell your healthcare provider if you have any side effects that bother you or don’t go away. What should I tell my healthcare provider before taking DESCOVY? •
All your health problems. Be sure to tell your healthcare provider if you have or have had any kidney, bone, or liver problems, including hepatitis virus infection.
•
All the medicines you take, including prescription and over-the-counter medicines, vitamins, and herbal supplements. Other medicines may affect how DESCOVY works. Keep a list of all your medicines and show it to your healthcare provider and pharmacist. Ask your healthcare provider if it is safe to take DESCOVY with all of your other medicines.
•
If you are pregnant or plan to become pregnant. It is not known if DESCOVY can harm your unborn baby. Tell your healthcare provider if you become pregnant while taking DESCOVY.
•
If you are breastfeeding (nursing) or plan to breastfeed. Do not breastfeed. HIV-1 can be passed to the baby in breast milk.
You are encouraged to report negative side effects of prescription drugs to the FDA. Visit www.fda.gov/ medwatch, or call 1-800-FDA-1088. Please see Important Facts about DESCOVY, including important warnings, on the following page.
Ask your healthcare provider if an HIV-1 treatment that contains DESCOVY® is right for you.
IMPORTANT FACTS (des-KOH-vee)
This is only a brief summary of important information about DESCOVY® and does not replace talking to your healthcare provider about your condition and your treatment.
MOST IMPORTANT INFORMATION ABOUT DESCOVY
POSSIBLE SIDE EFFECTS OF DESCOVY
DESCOVY may cause serious side effects, including:
DESCOVY can cause serious side effects, including:
• Buildup of lactic acid in your blood (lactic acidosis), which is a serious medical emergency that can lead to death. Call your healthcare provider right away if you have any of these symptoms: feeling very weak or tired, unusual muscle pain, trouble breathing, stomach pain with nausea or vomiting, feeling cold (especially in your arms and legs), feeling dizzy or lightheaded, and/or a fast or irregular heartbeat.
• Those in the “Most Important Information About DESCOVY” section. • Changes in body fat. • Changes in your immune system. • New or worse kidney problems, including kidney failure. • Bone problems.
• Severe liver problems, which in some cases can lead to death. Call your healthcare provider right away if you have any of these symptoms: your skin or the white part of your eyes turns yellow (jaundice); dark “tea-colored” urine; loss of appetite; light-colored bowel movements (stools); nausea; and/or pain, aching, or tenderness on the right side of your stomach area. • Worsening of hepatitis B (HBV) infection. DESCOVY is not approved to treat HBV. If you have both HIV-1 and HBV, your HBV may suddenly get worse if you stop taking DESCOVY. Do not stop taking DESCOVY without first talking to your healthcare provider, as they will need to check your health regularly for several months. You may be more likely to get lactic acidosis or severe liver problems if you are female, very overweight, or have been taking DESCOVY or a similar medicine for a long time.
ABOUT DESCOVY • DESCOVY is a prescription medicine that is used together with other HIV-1 medicines to treat HIV-1 in people 12 years of age and older. DESCOVY is not for use to help reduce the risk of getting HIV-1 infection. • DESCOVY does not cure HIV-1 or AIDS. Ask your healthcare provider about how to prevent passing HIV-1 to others.
The most common side effect of DESCOVY is nausea. These are not all the possible side effects of DESCOVY. Tell your healthcare provider right away if you have any new symptoms while taking DESCOVY. Your healthcare provider will need to do tests to monitor your health before and during treatment with DESCOVY.
BEFORE TAKING DESCOVY Tell your healthcare provider if you: • Have or had any kidney, bone, or liver problems, including hepatitis infection. • Have any other medical condition. • Are pregnant or plan to become pregnant. • Are breastfeeding (nursing) or plan to breastfeed. Do not breastfeed if you have HIV-1 because of the risk of passing HIV-1 to your baby. Tell your healthcare provider about all the medicines you take: • Keep a list that includes all prescription and over-thecounter medicines, vitamins, and herbal supplements, and show it to your healthcare provider and pharmacist. • Ask your healthcare provider or pharmacist about medicines that should not be taken with DESCOVY.
GET MORE INFORMATION HOW TO TAKE DESCOVY • DESCOVY is a one pill, once a day HIV-1 medicine that is taken with other HIV-1 medicines. • Take DESCOVY with or without food.
• This is only a brief summary of important information about DESCOVY. Talk to your healthcare provider or pharmacist to learn more. • Go to DESCOVY.com or call 1-800-GILEAD-5 • If you need help paying for your medicine, visit DESCOVY.com for program information.
DESCOVY, the DESCOVY Logo, GILEAD, the GILEAD Logo, and LOVE WHAT’S INSIDE are trademarks of Gilead Sciences, Inc., or its related companies. All other marks referenced herein are the property of their respective owners. © 2016 Gilead Sciences, Inc. All rights reserved. GILC0265 10/16
ON THE COVER 26 Empire Strikes Back Proof that TV star Jussie Smollet is the kind of HIV activist we need.
FEATURES 18 Welcome to the Resistance
Everything you need to know about battling HIV medication failure. Plus, new hope for fighting multi-drug resistant HIV.
17 A Dating App That Busts Hiv Stigma?
Alex Garner is helping Hornet empower gay and bi men to pursue dating, love, and great sexual health.
32 Sting Rae
Poz activist and media personality Rae LewisThornton doesn’t throw any punches.
PHOTO CREDIT
34 Revolutionary Battle
Hamilton star Javier Muñoz on doing Broadway with HIV and taking a stand against stigma today.
COVER: Jussie Smollett photographed by Mike Quan THIS PAGE: Helga Esteb/Shutterstock BACK COVER: Sampson McCormick by Don Harris
HIVPLUSMAG.COM | 3
JANUARY | FEBRUARY 2017 BUZZWORTHY 8 Zero Means Zero
Undetectable = Uninfectious.
9 Young, Queer, Black, Poz+
It adds up to one hell of an activist.
13 Bodies in Motion
Photographer captures athletes in all their, ahem, glory.
14 Triumph Over Tragedy
Elizabeth Glaser’s legacy astounds.
16 Chaos Theory
Guess what makes a Mess of young gay men's lives in new web series!
16 That Doesn’t Add Up
Who medical students won’t prescribe PrEP to may surprise you.
TREATMENT/TASP 36 Is Your Doctor Profiling You?
Racial bias is harming Black men’s health.
37 Don’t Forget Your Meds
Five ways to stay on top of your medication adherence.
38 New Year, New You
Expert advice on staying in shape with HIV.
40 On-Demand Massage MICHAEL BEZJIAN/TASIA WELLS, GETTY IMAGES (KLUM/GLASER); FLIKK THORNTON (RAE)
There's an app for that and we’re in love.
DAILY DOSE 42 Dear Gay Man, Your Friend Has HIV
If you’re a man who has sex with men, someone you know is HIV-positive—even if he hasn't told you yet.
BACK TALK 48 Connecting the Dots
Ashton Woods tackles the intersection of Black Lives Matter and efforts to end sexual violence, HIV criminalization, and trans discrimination.
HIVPLUSMAG.COM | 5
editor in chief DIANE ANDERSON-MINSHALL SVP, group publisher JOE VALENTINO
50 years
on of award-winning HIV coverage.
art director RAINE BASCOS senior editor JACOB ANDERSON-MINSHALL managing editor SAVAS ABADSIDIS editors at large TYLER CURRY, KATIE PEOPLES associate editor DAVID ARTAVIA editorial assistant ELAINE MENDUS contributing editors KHAFRE ABIF, MARK S. KING mental health editor GARY MCCLAIN creative director, digital media DAVE JOHNSON interactive art director CHRISTOPHER HARRITY online photo and graphics producers YANNICK DELVA, MICHAEL LUONG manager, application development ALEX LIM program manager VINCENT CARTE front end developer MAYRA URRUTIA traffic manager KEVIN BISSADA digital coordinator LAURA VILLELA director, integrated marketing JOHN MCCOURT managers, integrated marketing GRETA LIBBEY, JAMIE TREDWELL art director, integrated marketing PETER OLSON coordinator, integrated marketing RYAN WEAVER coordinator, integrated ad sales/marketing, CASEY NOBLE senior director, ad operations STEWART NACHT manager, ad operations TIFFANY KESDEN vp, marketing ROBERT HEBERT director of social media LEVI CHAMBERS editor, social media DANIEL REYNOLDS senior fulfillment manager ARGUS GALINDO operations director KIRK PACHECO production and office manager HEIDI MEDINA production services GVM MEDIA SOLUTIONS, LLC HERE MEDIA chairman STEPHEN P. JARCHOW ceo PAUL COLICHMAN cfo/coo TONY SHYNGLE executive vice presidents BERNARD ROOK, JOE LANDRY svp, editorial director LUCAS GRINDLEY senior vice presidents GREG BROSSIA, CHRISTIN DENNIS, LUCAS GRINDLEY, JOHN MONGIARDO, JOE VALENTINO vice presidents ERIC BUI, STEVEN CAPONE, ROBERT HEBERT ADVERTISING & SUBSCRIPTIONS Here Media, PO Box 5236, New York, NY 10185 Phone (212) 242-8100 • Advertising Fax (212) 242-8338 Subscriptions (212) 209-5174 • Subscriptions Fax (212) 242-8338 LOS ANGELES EDITORIAL PO Box 241579, Los Angeles, CA 90024 Phone (310) 806-4288 • Fax (310) 806-4268 • Email editor@HIVPlusMag.com SOUTHWEST EDITORIAL OFFICES Retrograde Communications, 43430 E. Florida Ave. Ste. F PMB 330, Hemet, CA 92544 Phone (951) 927-8727 • Email support@retrogradecommunications.com FREE BULK SUBSCRIPTIONS FOR YOUR OFFICE OR GROUP Any organization, community-based group, pharmacy, physicians’ office, support group, or other agency can request bulk copies for free distribution at your office, meeting, or facility. To sign up, just log on to HIVPlusMag.com/signup to subscribe. There is a 10-copy minimum. FREE DIGITAL SUBSCRIPTIONS Plus magazine is now available free to individual subscribers—a digital copy of each issue can be delivered to the privacy of your computer or reader six times per year. We require only your email address to initiate delivery. You may also share your digital copies with friends. To sign up, just log on to HIVPlusMag.com/signup and give us your email address. NEED SUBSCRIPTION HELP? If you have any questions or problems with your bulk or individual magazine delivery, just email our circulation department at Argus.Galindo@heremedia.com. Plus (ISSN 1522-3086) is published bimonthly by Here Publishing Inc., PO Box 241579, Los Angeles, CA 90024. Plus is a registered trademark of Here Media Inc. Entire contents © 2017 by Here Publishing Inc. All rights reserved. Printed in the USA. FOLLOW US ON FACEBOOK AND TWITTER
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6 | JANUARY / FEBRUARY 2017
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WATCH NOW AT HIVPLUSMAG.COM
Fabulous Gay Dance Video Makes HIV Prevention Sexy This fun music video joyfully educates gay and bi men about HIV prevention options. Set to the song, “Collect My Love,” by The Knocks (featuring Glee’s gender-bending singer Alex Newell), the flick follows some gay couples who meet at a club and are shown later negotiating condom use, taking PrEP, and with one character disclosing he’s HIV-positive and undetectable. The sex-positive, non-judgmental video is part of Centers for Disease Control and Prevention’s “Start Talking. Stop HIV.” campaign, which reaches out to men who have sex with men, particularly African-American and Latino gay and bi men. bit.ly/HIVClubVid
The Quarter-Life Crisis? The new webseries, Mess is a semi-autobiographical account of creator, writer, and star Paul Victor’s first six months of living with HIV. In the pilot, a group of multi-racial 20-something gay men are shown entangled with each other in various relationships. The story really takes off when Victor’s character (Andy) discovers he’s HIV-positive. The series paints a modern if messy view of love, life, relationships, and sex within a multicultural gay community, one complicated by HIV. Directed by Jason Lee Courson, the webseries is reportedly being considered for a television pickup. Read our interview with the Victor on pg. 16 and watch the first episode here. bit.ly/HIVMess
A S W E G O TO press,
EDITOR’S LETTER
we’ve just learned Donald Trump will be the next president of the United States. I don’t have to tell you it’s been a long, acrimonious election season and few of us have walked away from the anger and vitriol of this political battle unscathed. But while we could talk about how much fear and bitterness this election inspired in many of us, I choose to think about the wonderfully diverse and intelligent voices we heard rising from the margins time and again in 2016. This issue celebrates several of them, notably our cover guy, Empire star Jussie Smollett. The handsome young actor, who plays Jamal on Fox’s hit series, has been passionate and candid on screen and off. A child actor (remember The Mighty Ducks?), Smollet took time off from Hollywood to work half a decade for Artists for a New South Africa, raising money for children living with and affected by HIV or AIDS in South Africa and the U.S. As a star, he’s used his pulpit not just to talk about being Black and gay, but also about HIV on many levels: testing, safer sex, treatment, and finding a cure. When was the last time you heard a celebrity admonishing people to take their damn medication? Smollet was interviewed by his pal, comedian Sampson McCormick (best known only as Sampson), another gay performer who uses his art and audience to talk about the need for HIV testing and stigma reduction. (If you’ve never seen his standup show, now’s the time, because he’s about to blow up like Jussie!) There are some other rabble rousers living with HIV in these pages: longtime media personality and artist Rae Lewis-Thornton, Houston’s Black Lives Matter activist Ashton Woods, and Javier Munoz, the star of the Broadway hit, Hamilton. There’s the usual mix of treatment and prevention news, and best of all, a short but stigma shattering piece on why the National Institutes of Health now say people who are undetectable on treatment can not transmit HIV to anyone else. (So, yay, go on and have sex with your partners without anxiety and fear, or go make babies without the fear of transmission.) That’s a great start to what I hope is a fantastic 2017!
DIANE ANDERSON-MINSHALL EDITOR IN CHIEF EDITOR@HIVPLUSMAG.COM
(P.S. Oh, and if you’re doing the whole new year’s resolution to get in shape, we got you covered there too. See our workout tips on pg. 38.)
HIVPLUSMAG.COM | 7
buzzworthy
Zero Means Zero, People P R E V E N T I O N AC C E S S C A M PA I G N ’ S
— SAVAS A B A DS I D I S
SHUTTERSTOCK
U=U:Undetectable= Untransmittable is a film that seeks to educate the public about what it means for an HIV-positive person to be undetectable, now that research has proven those who are virally suppressed are uninfectious. Bruce Richman, PAC’s executive director, says U=U celebrates “the news that having an undetectable viral load means that we are not capable of transmitting the virus to our partners.” In 2016, the New England Journal of Medicine published the final results of HPTN 052, a study into whether antiretroviral medication alone is enough to prevent HIV transmission among serodiscordant couples. Researchers concluded that those who started antiretroviral therapy earlier were 93 to 96 percent less likely to transmit HIV to their partners than those who began their treatment later. But, Richman says, “96 percent reduction in risk is the wrong number” to focus on, because it was “based on early HIV treatment, not from a undetectable level …. The actual number for reduction in risk from undetectable levels is 100 percent.” Dr. Carl Dieffenbach, director of the Division of AIDS at the National Institute of Allergy and Infectious Diseases, agrees.
Speaking at the HIV Research for Prevention Conference in Chicago, Dieffenbach reported that, in all cases where HIV transmissions occurred in the study, there had been “treatment failure.” Either the HIV-positive partner had not been fully suppressed (to undetectable levels), or they had not taken their meds as prescribed and saw their viral loads rebound. In a Facebook Live interview for AIDS.gov, Dieffenbach said, “The most important number that we can focus on is this: If you are durably suppressed—meaning you have had a repetitive viral load test at or below detection—the chance of transmitting HIV to your partner, assuming you’re staying adherent, is zero. I’ll say it again: the chance of transmitting [HIV] if you are virally durably suppressed is zero.” Richman says Dieffenbach’s statement was particularly important because he represents the National Institutes of Health (of which the NIAID is a part of ). He argues that it’s also critical to have Dieffenbach and other experts speak out, because “virtually all HIV communications in the U.S. convey that there is still a risk, or warn that the risk—according to mathematic models—is not zero.” “Exaggerating the ‘danger’ we are to others is an act of violence against all of us with HIV,” Richman argues. “And it makes us vulnerable to a myriad of harms and injustices. We deserve and demand accurate and meaningful information. That is not only critical to our social, sexual, and reproductive health, but it is essential to end the epidemic.”
8 | JANUARY/FEBRUARY 2017
A RISING ACTIVIST SHOWS SHE’S THE ONE TO WATCH
T
RANISHA ARZAH, a young, queer-identified, Black feminist, rocked 2016. The 27-year-old peer advocate was named one of Plus magazine’s 75 Most Amazing HIV-Positive People of the year. She convinced Seattle’s mayor to declare April Youth HIV/ AIDS Awareness Month, and then helped pen the National Youth HIV & AIDS Awareness Day Bill of Rights, proclaiming that youth with HIV have the right: to an education; to HIV prevention, care, and treatment; and to live free from oppression, criminalization, discrimination, and stigma. “If we demand these rights,” Arzah, said at the time, “young people can not only thrive but lead the way toward a future where barriers to prevention, treatment, and care—like stigma and discrimination—no longer exist.” Last year, she attended the HIV is Not a Crime National Training Academy, and is actively working on changing Washington state’s laws criminalizing HIV-positive people. That commitment to decriminalization stems in part from her volunteer work at a Seattle youth detention center where she leads monthly discussions about HIV and prevention. “Every time I leave there,” she says, “I gain a more sense of purpose … [in] advocating for marginalized groups.” In 2016, Arzah was also one of 19 HIV activists who met with Presidential candidate Senator Bernie Sanders in San Bernardino, California. That’s the meeting that was later purportedly mischaracterized by Sanders, leading Arzah and others to draft the widely-read letter setting the record straight. Arzah attended the U.S. Conference on AIDS as a National Minority AIDS Council youth scholar. All the while she’s continued her work with BABES Network–YWCA, a peer education and support program for women living with HIV. She’s also a camp counselor and sits on the board of Positive Women’s Network-USA (an experience Arzah calls “monumental”). Not bad for an activist who tells us she has stopped fighting HIV. Born in 1990 to a Seattle couple struggling with drug addiction, Arzah perinatally-acquired HIV. “When I was younger, the only thing I knew was that I was sick.” she wrote in 2013. “So were my father, mother, brother, and grandparents. I was
about 4-years-old when my mom and brother passed away.” Arzah was put in foster care, and eventually adopted. “Instead of battling HIV,” Arzah says, she finally decided, “I was going to live my only life living with it and … not against it.” Today, Arzah is spurred on by her belief that “sexism, class oppression, gender identity, and racism are inextricably bound together.” Olivia Ford, a contributing editor at The Body, is one of many singing the young activist’s praise. She tells Plus that Arzah is “an intersectional thinker and changemaker, deftly and quite matter-of-factly making connections in her life and activism between patriarchy, heterosexism, transphobia, racism, classism, state violence, and the ongoing HIV epidemic.” — JA M
HIVPLUSMAG.COM | 9
APP
Out Magazine
(GORGEOUS) BODIES IN MOTION Pro athletes’s bodies are efficient machines, trained since youth for specific feats of strength and endurance. As photographer Ewoud
Broeksma’s images prove, that makes the body of an ideal soccer player remarkably different from that of a gymnast—especially when viewed
naked. Broeksma photographed Dutch hurdler Gregory Sedoc (left) for a 2004 calendar of Olympic athletes. “Although it’s often in the eye of the beholder, there is an inherit sexiness captured in the photos,” Broeksma says, preferring to call his athlete shots “pure” rather than naked or nude. Broeksma has celebrated the poetry of athletes in motion—in and out of uniform—in photo books Doubles and Doubles II, and is currently working with Patrick Mahoney on a new book, To Be Fit for Life. More info (and images) at Broeksma.com. — SA HIVPLUSMAG.COM | 13
buzzworthy
14 | JANUARY/FEBRUARY 2017
MICHAEL BEZJIAN/TASIA WELLS, GETTY IMAGES (KLUM); COURTESY EGPAF (ARCHIVAL PHOTOS); COURTESY JAKE GLASER (FAMILY PHOTOS)
ELIZABETH’S LEGACY In 1981, Elizabeth Glaser contracted HIV via a blood transfusion. After learning her two children were also positive—and losing her daughter, Arielle, to AIDS—Glaser launched what would become the Elizabeth Glaser Pediatric AIDS Foundation. Glaser (far left, with her children and co-founders) passed away in 1994. But her legacy lives on in son Jake, who now serves as an ambassador for EGPAF. The foundation has raised $35 million (preventing over 25 million cases of perinatally-acquired HIV) through star-studded Hollywood fundraisers. (Pictured this page, from top: Tom Cruise, Whoopie Goldberg, Drew Barrymore, Henry Winkler and Robin Williams at EGPAF events over the years). The foundation recently celebrated its 27th annual A Time For Heroes family festival with Glaser (middle with Heidi Klum), his father actor Paul Michael Glaser, and supporters including Mario Lopez, Zach Braff, Tori Spelling, and Donald Faison. “The reality of the world today is that living with HIV is like living with any other treatable disease,” Glaser told Plus. “If treated right, we can live long, happy and full lives with healthy families of our own. We do not need to subscribe to the stigma attached to HIV from the past. We live in a new world, one where we get to create our own way, and not be victim to this issue any more.” To honor his mother’s legacy, Glaser shared these family photos and EGPAF event snapshots.— JA M
HIVPLUSMAG.COM | 15
buzzworthy Young Gay Men’s Lives Get Messy in Web Series
Percent of Medical Students Willing to Prescribe PrEP
Mess, stars the show’s writer, Paul Victor, as newly poz, 20-something, Andy. He and his friends are entangled in complicated relationship and the quarter-life crises. We got Victor to explain. How autobiographical is Mess? It’s all a fictionalized version of real life. But yes, I am often as big a mess as Andy. I think most young people that move to a city like New York and are just sort of figuring out how to survive, go through a period where they’re not exactly … polished. How does Mess address stigma? When you put a face to something scary or taboo or whatever, it suddenly becomes real and grounded and therefore it can’t be as scary. Hopefully Mess helps put a face to HIV. Were you surprised by your own diagnosis? I think I was of the mindset that (a) I was invincible and (b) it happens to other people. But, I will say that for a fair portion of my adolescence, I thought that to be gay meant to have AIDS. I’m grateful every day that I live in an era where that’s not the truth. When I was diagnosed, I ... remember a very palpable sense of relief. Here was this thing that I was terrified of, and all of a sudden I had it and the world kept spinning and I didn’t die. And the joys of life, and the mundane of the day-to-day, and the craziness of being 22 and in New York, and not having any money—and all of that shit that I was already dealing with prediagnosis—was still there. The only thing that really changed was my perspective. And for that, I’m oddly grateful. Are people’s views on HIV changing? For a large portion of the people in my life—particularly back home—I am their only real-life representation of HIV. So living my life, and pursuing my dreams ... has changed some minds in that respect. There’s still plenty of people who think it’s a death sentence. Even in the gay community ... there’s slut shaming and this idea that if you’re poz or on PrEP then you’re super promiscuous and slutty and “asking” for it. I think part of that stems from the “it happens to other people” defense mechanism. All we
16 | JANUARY/FEBRUARY 2017
93% can do is be open and honest and tell our stories and hopefully break down stigma, person by person. I’m a believer in nudging the needle, not throwing out the meter altogether. I would say you can only change a mind that wants to be changed, but I’ve certainly been surprised in the past by how willing and open people are to hearing new perspectives. What's special about Mess? I believe that our show is something uniquely its own. The pacing and structure and tone of it, overall, is something I haven’t really seen before. And the subject matter is definitely something that isn’t explored much in mainstream entertainment. Young gay and bi men face a huge risk of becoming positive. Have HIV prevention messages failed? I think the biggest misstep of the messaging in the media is there’s sort of a gap in terms of HIV storytelling. Everything out there is a period piece of either the 1980s or 1990s when it was tantamount to a death sentence. So we’re brought up being terrified of this thing. Being scared leads to shame, and not getting tested or [not] being proactive about your sexual health, and a host of other issues that just don’t help anyone. Where are the stories of what HIV is like in the early 2000s? Today? Hopefully Mess does something to advance the overall story of HIV. And kids these days will have something to go to to say “Hey, this thing isn’t so scary after all.” Getting tested isn’t scary. Questioning condom use isn’t scary. Saying “no” isn’t scary. HIV isn’t something to take lightly, but we’re not living in the throes of a plague anymore. It’s never been easier to prevent HIV. It’s never been easier to treat HIV. This shit should be shouted from the rooftops and yet the media remains mostly quiet. — SA
if a monogamous HIV-discordant gay couple planned to continue using condoms
53%
if the couple wasn’t already using condoms
27%
if the couple was planning to stop using condoms while on PrEP Sarah Calabrese of Yale School of Public Health told attendees at the HIV Research for Prevention conference, “The patient who is at lowest risk is the one who is going to sustain his condom use, but he is the person who has the best access to PrEP.”
74%
number of PrEP users who are White
27%
number of new HIV diagnoses that are White Source: HIV Research for Prevention, 2016
Hornet’s Nest How ALEX GARNER is using the popular app for HIV prevention BY SAVAS A B A DS I D I S
COURTESY GARNER
A DVO C ACY
has always been essential to Alex Garner’s life and he firmly believes that the personal is political. Living openly as an HIV-positive gay man is something he does because he couldn’t bear not being honest about who he is. “But,” he adds, “I also choose to be open about who I am because I understand that affirmatively declaring who I am in a world where we continue to be marginalized and dehumanized is a powerful form of resistance.” You might not expect to find an HIV activist working at a dating app, but Garner is the senior health and innovation strategist at Hornet, where he’s using the platform to reach millions. Famous for initiating the “Know Your Status” campaign, Garner finds his work at Hornet an avenue for his activism and a chance to empower others to make healthy choices. Plus, he gets to play a role in changing the way that men meet on the ever prevalent apps. Hornet has a community of over 10 million users worldwide and provides various options for men to discover meaningful connections with each other. Garner is committed to providing the app’s users with as many resources as possible, so they can make informed decisions about their sexual health. Hornet’s Know Your Status feature (KYS on the menu bar) allows users to select an HIV status for their profile, and sign-up to receive regular reminders to get tested. Garner also understands the challenges that men encounter in the virtual space because of their HIV status. He believes very strongly in cultivating spaces where gay men are affirmed and empowered to take control over their sexual health. Garner says he has no regrets over choices he made. “There are many lessons I can learn from my past that can help me in the present or future,” he argues. But he still wants to empower young people to make different choices. In particular, he’s concerned by statistics that show high rates of new HIV infections among 13-24 year olds. According to the Centers for Disease Control and Prevention, as of 2014, youth in
that age bracket accounted for an estimated 22 percent of all new HIV diagnoses. Worse, new statistics show gay and bisexual men have a one in six chance of becoming HIV-positive in their lifetimes. “Even though gay men are the majority of infections and new infections in the U.S.,” Garner complains, “we do not receive the majority of resources and funding.” He blames that inequality on “an extension of a system of government and a culture that has not valued the lives and sexualities of gay men for over 35 years; in particular, gay men of color. This epidemic continues to expose the deep structural problems of racism, homophobia, xenophobia, poverty—and the list goes on.” Additionally, Garner fears an intense discomfort about gay sex still hampers public health responses and allows others to pathologize what gay and bi men do in bed. That aversion can also interfere in the care men who have sex with men receive from their health providers. “Gay sex, in all its varieties, must be celebrated,” Garner insists. “We need the resources and support to be empowered around the choices we make as we pursue pleasure, intimacy, and wellness.”
We need the resources and support to be empowered around the choices we make as we pursue pleasure, intimacy, and wellness.
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HIV can also become drug resistant, but most people are able to use antiretroviral combination therapy for many years without ever developing such a resistance. Fortunately, if you do develop a resistance, numerous treatment options are still available to take your current medication’s place. So don’t panic or lose sleep; even drug resistant strains of HIV can be treated these days. But you do need to know the facts about resistance, how it develops, what the symptoms are, and how it’s treated.
W H AT I S D R U G R E S I S TA N C E? Drug resistance occurs when a disease develops a defense to the mode of attack that a medication is using to fight it. Imagine if you arm yourself with a gun to protect your home, and then burglars buy bulletproof vests. That’s resistance. All organisms are constantly evolving to deal with the stressors in their environment, but whereas humans may appear unchanged over generations, organisms like viruses can change at a disturbingly rapid pace. Each HIV particle is actually short-lived, surviving only a couple of days. Unfortunately, the virus is very prolific during those 48 hours, and—after hijacking your T-cells, uses them to create billions of copies of itself in a given day. Because it’s reproducing so quickly, there’s a high probability of errors being made and then those errors being replicated. In fact, scientists believe in every reproduction cycle HIV makes at least one mistake.
“Avoiding resistance is more important than increasing your CD4 count. When a person with HIV isn’t on treatment, these mutations rarely offer an advantage over the initial strain, so the first (sometimes called “wild”) strain of HIV typically wins out. But once you’re taking antiretroviral medications, things change. In that case, if one of the millions of errors a day turns out to cause a mutation in the virus that makes it more resistant to the drugs being used to kill it, that mutation gives the new strain a competitive advantage over the wild version, and soon more of the mutated strain are replicating and passing on their drug resistance. If another error makes it even more resistant to that drug, the level of resistance continues to build, and eventually the medication stops working.
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I S R E S I S TA N C E T H AT CO M M O N? One of the reasons that HIV combination therapy uses three drugs today is so that even if one of the drugs is no longer working, the other two can. While strains of HIV that have developed resistance to two medications are found in about three percent of all new cases, strains that have become resistant to three drugs are much rarer, found in less than one percent (technically, 0.6 percent) of all new HIV cases, according to a 2012 study. Even so, without the three medications working in tandem, your viral load can begin to climb. And you’re unlikely to realize it’s happening. According to the British HIV treatment and advocacy site I-Base, “Avoiding resistance is more important than increasing your CD4 count because it will let your treatment work for many years.”
SY M P TO M S O F R E S I S TA N C E So how do you know if you have a drug resistant strain of HIV? The only way to know for sure is through testing. When you are first diagnosed with HIV, your doctor should check to see which strain you’ve got, as some strains are resistant to different drugs. If you have been on treatment, reached undetectable levels, and continued to adhere to your medications—but your viral load rebounds anyway— you should be tested for drug resistance. You should also be tested before you switch medications, as you’ll need to know whether your strain of HIV has a resistance to one type of drug. The National Institutes of Health also recommend drug-resistance testing for all HIV-positive pregnant women, whether they are on medication or not (because drug resistant strains can be perinatally transmitted to a child).
S TO P P I N G R E S I S TA N C E How do you keep HIV from developing a resistance to your medication? The risk of resistance increases when drug levels drop below a minimum active level. This usually only occurs if you miss doses or stop treatment. Getting on medication, adhering to your treatment as prescribed, not missing doses, and maintaining an undetectable viral load are your best defenses against developing resistance. As a 2005 study published in the Journal of Virology demonstrated, when your viral load is undetectable, HIV’s mutations appear to stop. While undetectable, the replication and errors that occur during the process are shut down. Unfortunately, that doesn’t completely eliminate the risk of developing a resistance. This was the situation with one gay couple, in a case presented by Erika Castro of Switzerland’s Lausanne University Hospital, at the 2010 Conference on Retroviruses and Opportunistic Infections. One of the men was on therapy and undetectable with a non-resistant strain of HIV; the other had been on antiretrovirals for five years but still had a detectable viral load and a multi-drug resistant strain of HIV. The resistant strain was transmitted from the one partner to the other. This is a reminder that being HIV-positive—and even being undetectable and uninfectious—does not prevent you from getting another strain of the virus, including a strain more difficult to treat than the one you have.
M E D I CAT I O N M AT T E R S According to a 2012 report, the Centers for Disease Control and Prevention learned that roughly two out of every 10 new cases of HIV involve strains with at least partial resistance to one or more antiretroviral medication. Some drugs have a higher risk of resistance and only need one mutation for the virus to gain complete resistance. This is particularly true with nonnucleoside reverse transcriptase inhibitors (nevirapine, efavirenz, rilpivirine, and etravirine), integrase inhibitors (raltegravir), and some nucleoside analogues like 3TC and FTC. These drugs are also more vulnerable if used in combinations that aren’t effective in maintaining viral loads below 50 copies/ml.
combination therapy uses three drugs to prevent Resistance from Developing. HIVPLUSMAG.COM | 21
• PREZCOBIX® is a prescription HIV-1 (Human Immunodeficiency Virus 1) medicine used with other antiretroviral medicines to treat HIV-1 infection in adults. HIV is the virus that causes AIDS (Acquired Immune Deficiency Syndrome). PREZCOBIX® contains the prescription medicines PREZISTA® (darunavir) and TYBOST® (cobicistat). • It is not known if PREZCOBIX® is safe and effective in children under 18 years of age. • When used with other antiretroviral medicines to treat HIV-1 infection, PREZCOBIX® may help:
dihydroergotamine (D.H.E.45®, Migranal®), ergotamine tartrate (Cafergot®, Ergomar®, Ergostat®, Medihaler®, Migergot®, Wigraine®, Wigrettes®), methylergonovine (Methergine®), lovastatin or a product that contains lovastatin (Altoprev®, Advicor®, Mevacor®), lurasidone (Latuda®), oral midazolam (Versed®), phenobarbital (Luminal®), phenytoin (Dilantin®, Dilantin-125®, Phenytek®), pimozide (Orap®), ranolazine (Ranexa®), rifampin (Rifadin®, Rifater®, Rifamate®, Rimactane®), sildenafil (Revatio®) when used for pulmonary arterial hypertension (PAH), simvastatin or a product that contains simvastatin (Simcor®, Vytorin®, Zocor®), St. John’s Wort (Hypericum perforatum) or a product that contains St. John’s Wort, or triazolam (Halcion®).
○ reduce the amount of HIV-1 in your blood. This is called “viral load.”
• Serious problems can happen if you take any of these medicines with PREZCOBIX.®
○ increase the number of CD4+ (T) cells in your blood that help fight off other infections.
What should I tell my healthcare provider before taking PREZCOBIX®?
• PREZCOBIX® is always taken in combination with other HIV medications for the treatment of HIV-1 infection in adults. PREZCOBIX® should be taken once daily with food. • PREZCOBIX® does not cure HIV-1 infection or AIDS, and you may still experience illnesses associated with HIV-1 infection. You must keep taking HIV-1 medicines to control HIV-1 infection and decrease HIV-related illnesses. • Ask your healthcare provider if you have any questions on how to prevent passing HIV to other people. • Please read the Important Safety Information below and talk to your healthcare provider to learn if PREZCOBIX® is right for you.
IMPORTANT SAFETY INFORMATION What is the most important information I should know about PREZCOBIX®? • PREZCOBIX® may cause liver problems. Some people taking PREZCOBIX® may develop liver problems which may be life-threatening. Your healthcare provider should do blood tests before and during your treatment with PREZCOBIX.® ○ Chronic hepatitis B or C infection may increase your chance of developing liver problems. Your healthcare provider should check your blood tests more often. ○ Signs and symptoms of liver problems include dark (tea-colored) urine, yellowing of your skin or whites of your eyes, pale-colored stools (bowel movements), nausea, vomiting, pain or tenderness on your right side below your ribs, or loss of appetite. Tell your healthcare provider if you develop any of these symptoms. • PREZCOBIX® may cause severe or life-threatening skin reactions or rash. Sometimes these skin reactions and skin rashes can become severe and require treatment in a hospital. Call your healthcare provider right away if you develop a rash. ○ Stop taking PREZCOBIX® and call your healthcare provider right away if you develop any skin changes with symptoms such as fever, tiredness, muscle or joint pain, blisters or skin lesions, mouth sores or ulcers, red or inflamed eyes like “pink eye” (conjunctivitis). • PREZCOBIX,® when taken with certain other medicines, can cause new or worse kidney problems, including kidney failure. Your healthcare provider should check your kidneys before you start and while you are taking PREZCOBIX.®
• About all health problems. Tell your healthcare provider if you have liver problems, including hepatitis B or hepatitis C, have kidney problems, are allergic to sulfa (sulfonamide), have diabetes, have hemophilia, or have any other medical condition, are pregnant, breastfeeding, or plan to become pregnant or breastfeed. Tell your healthcare provider if you become pregnant while taking PREZCOBIX.® • About all medicines you take. Tell your healthcare provider about all the medicines you take, including prescription and over-the-counter medicines, vitamins, and herbal supplements. Some medicines interact with PREZCOBIX.® Keep a list of your medicines to show your healthcare provider and pharmacist. Do not start taking a new medicine without telling your healthcare provider. Your healthcare provider can tell you if it is safe to take PREZCOBIX® with other medicines. What are the possible side effects of PREZCOBIX®? • The most common side effects of darunavir, one of the medicines in PREZCOBIX,® include diarrhea, nausea, rash, headache, stomach area (abdominal) pain, and vomiting. • Other possible side effects include: ○ High blood sugar, diabetes or worsening diabetes, and increased bleeding in people with hemophilia have been reported in patients taking protease inhibitor medicines, including PREZCOBIX.® ○ Changes in body fat can happen in people who take HIV-1 medicines. The exact cause and long term health effects of these changes are not known. ○ Changes in your immune system (Immune Reconstitution Syndrome) can happen when you start taking HIV medicines. Your immune system may get stronger and begin to fight infections that have been hidden in your body for a long time. These are not all of the possible side effects of PREZCOBIX.® For more information, ask your healthcare provider. Tell your healthcare provider if you have any side effect that bothers you or that does not go away. You are encouraged to report negative side effects of prescription drugs to the FDA. Visit www.fda.gov/medwatch or call 1-800-FDA-1088. You may also report side effects to Janssen Products, LP at 1-800-JANSSEN (1-800-526-7736). Please read accompanying Important Brief Summary for PREZCOBIX®.
Who should not take PREZCOBIX®? • Do not take PREZCOBIX® with any of the following medicines: alfuzosin (Uroxatral®), carbamazepine (Carbatrol®, Epitol®, Equetro®, Tegretol®, Tegretol-XR®, Teril®), cisapride (Propulsid®), colchicine (Colcrys®, Mitigare®, if you have liver or kidney problems), dronedarone (Multaq®), elbasvir and grazoprevir (Zepatier®),
Janssen Therapeutics, Division of Janssen Products, LP © Janssen Therapeutics, Division of Janssen Products, LP 2016 11/16 051975-161017
061037-161017
WHAT IS PREZCOBIX®?
ASK YOUR DOCTOR ABOUT DRUG RESISTANCE AND ONCE-DAILY* PREZCOBIX®
Wisdom inspired by real people
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“I’M TAKING STEPS TO HELP MY TOMORROW.” When deciding on an HIV treatment, think long term. Everyone is at risk of developing drug resistance. Once-Daily* PREZCOBIX® has a high genetic barrier to resistance, which may help. PREZCOBIX® is taken in combination with other HIV medications for the treatment of HIV-1 infection in adults.
*
ONCE-DAILY
*
PREZCOBIX.com
“Learning is part of my journey. Asking questions helps me feel more confident.”
PREZCOBIX® (prez-koe-bix) (darunavir and cobicistat) tablets
What is PREZCOBIX® used for? PREZCOBIX® is a prescription HIV-1 (Human Immunodeficiency Virus 1) medicine used with other antiretroviral medicines to treat HIV-1 infection in adults. HIV is the virus that causes AIDS (Acquired Immune Deficiency Syndrome). PREZCOBIX® contains prescription medicines PREZISTA® (darunavir) and TYBOST® (cobicistat). PREZCOBIX® does not cure HIV-1 infection or AIDS. You must keep taking HIV-1 medicines to control HIV-1 infection and decrease HIV-related illnesses. What are the most serious warnings about PREZCOBIX®? • PREZCOBIX® may cause liver problems which may be life-threatening. Tell your healthcare provider right away if you have any symptoms such as: • Vomiting • Dark (tea-colored) urine • Pain or tenderness on your right side below your ribs • Yellowing of your skin or the whites of your eyes • Loss of appetite • Pale-colored stools (bowel movements) • Nausea • PREZCOBIX® may cause severe or life-threatening skin reactions or rashes. Stop taking PREZCOBIX® and call your healthcare provider right away if you develop any skin changes with symptoms below: • Blisters or skin lesions • Fever • Mouth sores or ulcers • Tiredness • Red or inflamed eyes, like “pink eye” (conjunctivitis) • Muscle or joint pain • PREZCOBIX,® when taken with some other medications, can cause new or worse kidney problems, including kidney failure. What do I need to tell my healthcare provider? Tell your healthcare provider if you: • Have liver problems, including hepatitis B or hepatitis C • Have kidney problems • Are allergic to sulfa (sulfonamide) • Have diabetes • Have hemophilia • Have any other medical condition
• Are pregnant or plan to become pregnant. (It is not known if PREZCOBIX® will harm your unborn baby. Tell your healthcare provider if you become pregnant while taking PREZCOBIX.®) • Are breastfeeding or plan to breastfeed. Do not breastfeed if you take PREZCOBIX® because it is unknown if PREZCOBIX® can pass into your breast milk. You should not breastfeed if you have HIV-1 because of the risk of passing HIV to your baby.
Tell your healthcare provider about all the medicines you take, including prescription and over-the-counter medicines, vitamins, and herbal supplements. Some medications may prevent PREZCOBIX® from working or cause increased side effects. Do not start taking a new medicine without telling your healthcare provider. Who should not take PREZCOBIX®? • Do not take PREZCOBIX® with any of the following medicines: alfuzosin (Uroxatral®), carbamazepine (Carbatrol®, Epitol®, Equetro®, Tegretol®, Tegretol-XR®, Teril®), cisapride (Propulsid®), colchicine (Colcrys®, Mitigare,® if you have liver or kidney problems), dronedarone (Multaq®), elbasvir and grazoprevir (Zepatier®), dihydroergotamine (D.H.E.45®, Migranal®), ergotamine tartrate (Cafergot ®, Ergomar ®, Ergostat ,® Medihaler,® Migergot,® Wigraine,® Wigrettes®), methylergonovine (Methergine®), lovastatin or a product that contains lovastatin (Altoprev,® Advicor,® Mevacor ®), lurasidone (Latuda®), oral midazolam (Versed®), phenobarbital (Luminal®), phenytoin (Dilantin®, Dilantin-125®, Phenytek®), pimozide (Orap®), ranolazine (Ranexa®), rifampin (Rifadin,® Rifater®, Rifamate®, Rimactane®), sildenafil (Revatio®) when used for pulmonary arterial hypertension (PAH), simvastatin or a product that contains simvastatin (Simcor,® Vytorin,® Zocor ®), St. John’s Wort (Hypericum perforatum) or a product that contains St. John’s Wort, or triazolam (Halcion®). • Serious problems can happen if you take any of these medicines with PREZCOBIX.® What are the possible side effects of PREZCOBIX®? PREZCOBIX® may cause serious side effects including: • Diabetes and high blood sugar • Changes in body fat can happen in people taking HIV-1 medications • Immune system changes (Immune Reconstitution Syndrome) can happen in people who start HIV-1 medications • Increased bleeding can occur in people with hemophilia who are taking PREZCOBIX.® The most common side effects are: • Diarrhea • Headache • Nausea • Stomach area (abdominal) pain • Rash • Vomiting These are not all of the possible side effects of PREZCOBIX®. For more information, ask your healthcare provider. What should I know about this Brief Summary? This information is not complete. To get more information: • Talk to your healthcare provider or pharmacist • Visit www.PREZCOBIX.com to read over the FDA-approved product labeling and patient information • Call to report side effects either to the FDA at 1-800-FDA-1088 or to Janssen Products, LP at 1-800-JANSSEN (1-800-526-7736). © Janssen Therapeutics, Division of Janssen Products, LP 2016 10/16 054195-160602
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When the virus develops a resistance, there is often cross-resistance to similar drugs in the same class. Cross-resistance occurs when a mutation that gives the virus an edge against one medication also gives the virus resistance to similar drugs, even if you’ve never taken them before. This is most common among drugs in the same class, so if you develop a resistance to one NNRTI (like rilpivirine), then another NNRTI (like efavirenz) is also unlikely to work. Fortunately, some drugs offer more protection from HIV developing resistance. The the 48-week ODIN trial found that darunavir (a component of both Prezista and Prezcobix) has a high genetic barrier to HIV developing drug resistance. It stops the virus both from multiplying and mutating. Decreasing the rates of duplication and cutting down on the number of errors the virus makes reproducing, dramatically reduces the opportunity for drug resistant mutations to appear and replicate. While Prezcobix is less prone to drug resistance, it shouldn’t be taken by those who’ve developed drug resistance to darunavir. The most important things to remember about drug resistance are to get testing before starting treatment, work with your doctors to determine the best medication for you, adhere to your treatment, and get/keep your viral load undetectable. And, importantly, if you do develop a resistance, talk to your doctor about switching medications. Just because you’ve developed a resistance to one drug—or even a whole class of drugs—doesn’t mean that other HIV meds won't work for you. Remember, HIV strains with multiple drug-class resistances are rare and, so far, none have shown the kind of treatment-wide resistance that gonorrhea is developing to antibiotics. So don’t lose sleep over your drug resistant strain of HIV—just hit it with a different combination therapy.
New Hope in Fightng Multi-Drug Resistant HIV A new, long-acting injectable HIV medication offers hope for those who have multi-drug resistant strains of HIV. Early findings from Phase 3 trials show that ibalizumab, a drug developed by Theratechnologies Inc., has been effective in significantly decreasing viral loads after just the first week of treatment. Revealed at ID Week 2016 in New Orleans, the results are based on 40 participants with multi-drug resistant strains of HIV who were given a shot of 2,000 mg of ibalizumab in addition to their failing antiretroviral therapies—or no therapy at all. Seven days later, 83 percent had achieved a decrease in their viral loads and 60 percent saw a decrease above 1.0 log10. According to study author Dr. Jacob Lalezari, CEO of San Francisco’s Quest Clinical Research, a “one log decrease in viral load represents a 90 percent decrease in virus.” While that sounds impressive, it wouldn’t make the drug potent enough as a single therapy, but combined into a cocktail with other drugs it will offer effective treatment. More than 85 percent of participants came to the study with at least one identified mutation, conferring resistance to nucleoside reverse transcriptase inhibitors (like Viread), non-nucleoside reverse transcriptase inhibitors (like Rescriptor), or protease inhibitors (like Lexiva); and more than 60 percent had resistance to at least one integrase inhibitor (like Isentress). On average, the participants’ strains of HIV were resistant to more than 75 percent of all drugs in the NRTI, NNRTI, and PI classes; as well as to one or two drugs from the INI class. Finally, 50 percent of patients had a strain with resistance to all available drugs from at least three classes of antiretrovirals. Lalezari tells Plus, “The HIV virus is a complex pathogen that finds ways to elude treatment by mutating to become resistant.” While only 0.6 percent of all new HIV cases are resistant to three classes of drugs, that’s still thousands of people, who Lalezari says, “have limited or
no remaining options to treat their infection.” Because drug resistant strains can also be transmitted to others, there’s pressing need develop new therapies. That’s what makes ibalizumab potentially so exciting, Lalezari says, “If approved by the FDA, [it] would be the first long-acting biologic to show such efficacy in patients with highly resistant HIV-1." Furthermore, he says, ibalizumab may help to reduce viral loads in patients whose HIV cannot be controlled by currentlyavailable treatments. "When combined with other agents, ibalizumab could help these patients in dire need of new treatment options, and could change the way multi-drug resistant HIV is managed in the future.” The biggest news here is that ibalizumab will be the first long-acting non-oral therapy approved for treating HIV. As renowned HIV doctor Dr. David Ho told the 2016 U.S. Conference on AIDS, “Injectables are the future of HIV treatment,” because they take the issue of adherence out of the picture. “These drugs could become important in combination with other drugs, and could offer a subset of patients an alternative to daily oral therapy," adds Lalezari. That’s one reason the Food and Drug Administration declared ibalizumab a “breakthrough therapy,” a designation that speeds up the approval process for new therapies treating serious and life-threatening conditions, when they may provide a substantial improvement over what is currently available. The last clinical trial required by the FDA—the 24-week ibalizumab Phase III study—wrapped last October, but the final findings were not available as this issue went to print. Still, these initial results are very positive, and Theratechnologies Inc has already started recruiting participants for an “expanded access study,” which will give needy patients (who didn’t qualify for the clinical trial) access to the new drug prior to official FDA approval.
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26 | JANUARY / FEBRUARY 2017
CRAZY SEXY COOL
Empire star JUSSIE SMOLLETT and comedian SAMPSON MCCORMICK get real about the responsibility of being Black gay artists, the quest for an HIV cure, and what’s really at the root of homophobia and oppression.
THE
beauty of Hollywood is that TV stars seem to spring up out of nowhere. A guy becomes an “overnight” sensation, and suddenly half of America is dreaming about him in the bathtub. Never mind the decades of work prior; to American audiences it’s as if he never existed before. That’s the case with Jussie Smollett, star of Fox’s hit hip-hop drama, Empire. A child actor in the early 1990s, Smollett starred in films like The Mighty Ducks and North; and, with his five real-life siblings, in the TV show On Our Own. After it was cancelled, Smollett took a ten year break from Hollywood, to shine as a different kind of star in the world of activism. Coming out as gay and being open about walking “truly in my blackness,” has gotten him a fair share of critics. (His response to detractors? “Thanks but no thanks, fuck you, and goodbye,” he told Attitude magazine earlier this year.)
COUTRESY OF FOX
There are few actors today willing to go where Smollet does. He doesn’t just share his opinions
on broad cultural issues like race, LGBT rights, HIV, and politics. Smollet actually breaks open his heart to reveal his own worries as a Black gay man—and to advocate across the aisle for social justice for all. Smollett began his activism as a child actor and has seen his career and his sense of global citizenry expand concurrently. Around performers all his life, he treats the Hollywood machinery more like an amusement than something he’s striving to be part of. He’s known celebs since childhood (including Naomi Campbell, who he first met as an 8-year-old). Some of his siblings are still acting (including True Blood’s Jurnee Smollett-Bell) and his mentor is Phill Wilson, CEO of Black AIDS Institute, the only national HIV think tank focused exclusively on African-Americans. In 2017, Smollett will see his star go supernova. In February, he and Empire co-star Taraji P. Henson become the newest faces of MAC AIDS Fund’s VIVA GLAM campaign. He’ll also star in Ridley Scott’s sure-to-be-a-blockbuster movie, Alien: Covenant. And of course, he's stil on Empire, the TV show that’s now impacting everything from fashion and merchandising to the overall look of American television. We asked comedian Sampson McCormick— Smollett’s good friend and another rising star (read more about the comic on page 31)—to have a sit-down with Smollett for Plus. It isn’t just a friendship that unites them. “We’re very proud of both our skin color and our sexualities, because for us, I think, both are equally important,” says McCormick, who admires Smollett’s deep commitment to justice. “That’s one thing I love about him. He’s an artist for sure, but he’s also very connected to real issues, and we need more people like him. To be a Black gay person, and to see others in the business… who use their voices to address the issues is [inspiring].” Smollett jokes that he and McCormick could be like Jerry Lewis and Dean Martin. It’s not hard to believe once you witness their comedic timing, vocal chops, and easy banter.
EDITED BY DIANE ANDERSON-MINSHALL ADDITIONAL RESEARCH BY SAVAS ABADSIDIS
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it because it’s happened to me, it’s happening to my sisters and my brothers and humanity. I just feel like if people are listening to you, you should have something to say. S M : Absolutely. J S : With the light and the platform that we have been given, I’m certainly not gonna shut up now. Now is not the time. Well it’s never the time. It’s never the time until it is the time.
S A M P S O N : We both try to use our voices to be a part of addressing social issues that affect our communities as Black, gay men. It’s not the cool thing to do. Why do you think it’s important to use art and our voices to deal with things like LGBT, homelessness, Black Lives Matter, or HIV issues? J U S S I E : Well I’ve said this before: I believe that it is our responsibility, but I believe that it is our responsibility because we live on this planet. You know what I’m saying? And I just think that whatever our platform is, it’s our responsibility, and sometimes it seems like its more one group of people’s responsibility more than another because those are the ones that get the light shined on them. I’m no different [now that I’m famous]. My tweets are no different. My Instagrams are no different. The meetings that I go to are no different. The legislation that I pull for is no different, or the way that I pull for legislation, the marches that I go on, the way that I speak up is no different. It’s just that more people are listening now. That, if anything is my message, it’s that it’s not about, “Why is it the artist’s responsibility?” It’s, “Why is it the human being’s responsibility?” If we fucked up this world, we gotta clean it up. It’s a human being’s responsibility. It’s just that the artist, to me—sometimes we are told that we should shy away from what is our civic duty and what is just our rights and our duty as citizens. That somehow … we’re supposed to shut our mouths. So many times I’ve gotten … [asked], “Why don’t you shut up and stop talking about race? Don’t you have some acting to do?” First of all, that’s all you’ve got? That’s a whack-ass shit you’re gonna say. And it’s just really interesting and I’ve heard that before, but that’s just not my point of view, because I don’t approach it as an actor, I approach it as a concerned person who is affected by
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S M : Yeah, I just went out and I was like, what y’all gonna do, huh? Y’all gonna try to do something to me? [Laughing] I mean, but we laugh at it, and we make fun out of it, and we deal with it in a lighthearted way. I’ve always believed that especially with Black folks, we’ve always used humor to overcome issues. But, I cannot figure out why people will take time out of their day [to protest performers]. Look at people like ministers for instance, who are in churches, who rather than ministering about the need to feed the hungry or clothe the naked or house the homeless, [they] move away from that and they’re more aggressive about demonizing the LGBT community. One big thing that I grew up listening to was that HIV was God’s punishment to gay people. J S : Remember those shirts that ... I forget who was the rock star who wore it, and it said, “AIDS kills fags dead.” I remember seeing that and being like, wow. Here’s the thing. We don’t all have to see the world the same way. I think that [it]’s so important for us to get that message out. We don’t all have to see the world in the same way. You are actually allowed to feel that being gay is wrong. You are, absolutely, because I might think that your fucked up haircut is wrong. But you have the right to have that fucked up haircut. S M : A lot of [people] who think gay rights are wrong, they have fucked up haircuts because they don’t have gay friends. J S : You only become a horrible person when you violate my basic human rights. That is when it becomes a problem, when you start being the aggressor in two consenting adults and the life that they live. That is what makes you an asshole. It’s this lack of understanding, it’s this lack of care. SM: Why can’t people mind their damn business? J S : Because everybody wants somebody to
AP/ANDREW HARNIK (OBAMA); AP/RICHARD SHOTWELL (JURNEE)
S M : I do shows and I get protesters. I think I told you the Klan came to a show I did earlier this year. People get genuinely angry. J S : You took that shit on like Bessie Smith.
oppress. Really think about that. Everybody wants somebody to oppress, and that’s why even we who are oppressed—whether it be the LGBTQ community, whether it be communities of color, whether it be women—we are all oppressed communities, but even the oppressed want to oppress, because we’ve been taught by society that to be the oppressor means that we are the one that holds the power. S M : Oh, you better preach. J S : You know what I’m saying though? Everybody wants power. Everybody wants to be powerful. It’s just everybody projecting their own insecurities. Nobody—I’m telling you, I promise you—nobody really wants to be homophobic. Nobody really wants to be that way. We are a product of our environment and what we are taught, and we are taught to believe that we are supposed to be that way. S M : Wow. J S : Trust me, I see it. People don’t want to be homophobic. People are taught that that is the way that you are not a homosexual, is to be homophobic. The real motherfuckers who are really, really secure in themselves, they don’t give a fuck who I love. They don’t give a fuck. They chillin’ with their girl. Like, they good. They are not concerned with who I’m dealing with. That’s just not their type, just like they may not like a blonde. They may not like a brunette. You feel me? I have three straight brothers.
AP/JOHN SALANGSANG
S M : Right, they don’t care. J S : [Homophobia] is the brainwashing of society. It’s the poisoning of hate. That’s what it is. One of my biggest mentors, Phill Wilson, after the Charleston shootings, I was so low, and it was right when I was being honored at the Heroes in the Struggle last year. And I was so down, I could not stop. It was one of the first times that I felt just completely defeated. [Phill] said to me and Jeremy, he said it like this:“These are extremely, extremely desperate people. They are such desperate people, because hate is so desperate right now, because hate is going to lose.” When hate is gonna lose, hate starts getting real low, hate starts getting real, trying everything. Well, I’m gonna shoot you; well I’m gonna do this. That’s what hate does. That’s what Donald Trump does. S M : You think that’s where Donald Trump came from? J S : Absolutely. I think that these are desperate times, desperate, desperate, desperate people. I’m not saying that every single Donald Trump sup-
porter is a desperate person. No, actually I am. I am, but [he is] playing to people’s fears, fears of being less powerful. What happens if somebody walks up to you when you were a kid, and a new baby is born, and somebody walks up to you and is like, “Oh you’re not the baby no more. Oh, you’re not the hottest one no more.” You are filling this person’s mind as if they are supposed to be competing with this other person. Therefore, there is going to be some sort of resentment to that other person. And that’s what society does. That’s what hate does. That’s what racists and bigots and all of them do. And homophobes, that’s what happens. I didn’t need Donald Trump to come along to tell me that the United States is racist, and the most desperate people are now gonna flip the script and call [us] the villain. All of a sudden, these other people—.
O P P OS I T E PAG E (TOP) First lady Michelle Obama welcomes Jussie Smollett at the White House last year. (BOTTOM) Smollett and his sister, Jurnee, at the 16th Annual Heroes in the Struggle Gala in 2015. B E LOW Smollett and Eva Longoria pal around at HollyRod’s 17th Annual DesignCare Gala in 2015.
S M : Yeah, but you know what though? Some people did need Donald Trump to come along to show us that the nation is racist. I mean, I knew this country was racist … systemically racist, systemically homophobic, and sexist and all these different things. But to see it and listen to these people—who are part of these militias and things—threaten to go stand outside of voting places, polling places, and intimidate voters … I don’t want to say it’s frightening, but … I was appalled, I was shocked. I don’t know how to feel about it. I’m very paralyzed by that feeling, like the fact that these are elderly people going to vote, these are disabled people, these are people who need to have a voice and [the racists are] basically using violence to try to suppress people. It’s that last effort to maintain this ridiculously hateful power. J S : Sometimes I feel like I can’t even talk about it because it makes ... You know when your blood starts feeling like its boiling over your heart? You ever had that feeling? S M : Oh honey, when they don’t send my checks on time, yes. J S : Oh lord, help us all. No, but that is that feeling, but that … feeling of the fake intimidation.
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Smollet as Jamal with the Empire cast.
S M : I know you’ve always been a very big advocate for social justice around HIV. Why has that been so important to you? J S : When I was young, we were really close to someone that worked on the set of our show, in the early ’90s. And he all of a sudden just disappeared, and he was gone for a couple weeks, then maybe two months, and then… my mom told us that he passed. He had passed away from AIDS [complications]. I was 10 and it was devastating. I remember the feeling of devastation. I remember being young and thinking, we loved him so much just from working with him for a couple months, imagine how his family feels. My mother was always the advocate for justice in any form, so we started learning more and more and more and more about HIV, AIDS, and just from there really did get truly involved. We started working with Artists for a New South Africa when I was about 14. Phill Wilson became one of my mentors when I was 16, and I started volunteering with the Black AIDS Institute, and then started working for Artists for a New South Africa … which was a group of artists led by Alfre Woodard and Carlos Santana and Samuel L. Jackson and LaToya Jackson and these amazing players, these amazing artists, they all came together. During apartheid, it
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was Artists for a Free South Africa, and then they changed it after apartheid was gone and Mandela became president.They changed it to Artists for a New South Africa, and I worked there for five years in the office, raising funds for children infected and affected by HIV and AIDS in South Africa and also in the states. It’s one of the things that we are about. And I just feel like, in this day and age, it’s kind of—I hate this term, but it’s not necessarily this "sexy" thing to care about anymore. I understand that there are so many things in the world happening, but we have to care about this also. We just have to. If you sit idly by and you get content with what’s going on than you end up … believing that we’re done, when we’re just not. Contentment can easily lead to apathy. S M : Definitely. I think a lot of people have gotten [complacent] … people seem to have a more nonchalant attitude about HIV and AIDS. J S : That’s the thing, though. With every single progress that you make in any situation, it just means that the root of the issue has to be talked about more. Now you don’t have to worry about getting tested, you don’t have to worry about this, you don’t have to—No! No, no, no, no, no, no. It doesn’t work like that. This is not a cure. This does not protect you from other things. We still have to take responsibility for ourselves and each other. I don’t want that to somehow … end up losing more … because we’re being careless through the progress. S M : HIV is a global issue; something that we all are definitely affected by. But if you look at the statistics it’s clear to see that in the Black community, Black folks—whether they’re gay, bi, or straight—are disproportionately affected by HIV and AIDS. What do we do as a community to bring light to the issue, really start taking it seriously, and most of all, make a change in the community? J S : We have to mobilize. We have to educate ourselves. I think about [this question] all the time. I wish that I had an answer that I could really be proud of instead of saying the same old shit: “We have to discuss it, we have to get tested, we have to talk to our partners.” I know that to be true, but now I want to talk more. I want to talk about what else can we do, though, because there has to be something else. That’s the discussion I would really like to start: What else can we do? Because I wish that we could start to admit that we’re kind of hitting a wall. And I wish that we could admit that we don’t know what we’re supposed to do. That discussion in itself is so important.
COUTRESY OF FOX/JAMES DIMMOCK
S M : Let's talk about HIV. J S : HIV has been stigmatized and even criminalized. Why is that? I don’t think that it’s really up for debate that if [HIV] all of a sudden started really attacking white heterosexual men, it would be taken very seriously. I mean, am I wrong? It would be taken very, very seriously.
S M : Right, right, right. JS: We all know that we’re supposed to get tested. We all know that ... Or maybe we don’t. Actually, we don’t all know that, so fuck that. Fuck what I just said. We all need to talk more about this. No, but seriously, we all need to talk more about the things that we don’t know, and we also need to talk about the things that we do know. There’s so many on both sides. I may not know something, and I may talk about the fact that I don’t know this, and you may know the answer. I may talk to you about something that I do know that you don’t know. We need to sit there and open up some sort of [dialogue]. It just crushes me that people in this day and age still feel alone and still feel ashamed and they still feel this stigma put upon them. That’s what breaks my heart: in 2017, there are still people living in chains of who they are, of what they’re going through, and in turn, shame leads to denial, denial leads to irresponsibility. We can talk about this forever. I hope y’all got enough sound bites to get the damn, real message across. Can I be honest with you? Sometimes these interviews get on my nerves … I’m not saying this interview in particular, this interview feels good because it’s with a friend, it’s about something real. But sometimes these interviews ... they get on my nerves because it’s almost like people are just looking for the next sound bite, [they] don’t want have a real discussion about what the fuck is going on. S M : You’re about to open up another can of worms. JESSE: They don’t really want to open up that discussion. They really just want to talk about what they’re comfortable enough talking about and knowing in order to let them sleep at night. They put up a sound bite from an activist or an artist or something like that that people might see. Are we really, really seeing what is happening out there? Are we really, really seeing what people are going through? Or are we just figuring this is something to write about today, this is something to talk about today? I don’t know. I just feel sometimes like we’re so caught up in cliches and hashtags and all this type of stuff that we’re not really even thinking about what really to do to solve the problem. We’re always talking about the problem, but what is the solution? Let’s start talking about the solutions. S M : And what about a cure? J S : Don’t get me started. I truly believe that there is a cure out there. And the moment that we can actually get out there, we can actually get the governments to finally make money off of that cure, maybe we will see it. S M : Well, I got to talk to you off record. J S : Let me go call my security detail, because after this I’m gonna need extra security. No, I mean, y’all can print that shit. Honestly. It’s true. S M : I think so too, because I mean [someone’s] gonna make money. J S : But here’s the thing. Until we can uncover that [cure], you gotta take your fucking meds and you gotta get fucking tested!
DON HARRIS
S M : Absolutely. Absolutely, and take care of yourselves. J S : Please, please, please. Hey, I’m not the one that’s sitting here being like, “Believe everything that’s said to you.” I am the one that’s being like, “Listen, until we can really uncover that [cure], until we can really uncover that, I need for y’all to fucking get tested, and I need for you to be responsible. I need for you to get treatment, and I need for you to take care of yourself.” S M : Well I think you can drop the mic on that one, because it is what it is. J S : I’m dropping the mic.
Comedy Man Gay comic Sampson McCormick is hoping to navigate territory that Moms Mabley and Redd Foxx pioneered.
IN
the days leading up to the presidential election, it hasn't been easy to be a gay Black comedian. McCormick confronted white supremacists at one of his shows. But he kept soldiering on, performing a comedy routine lauded for bridging race, age, culture, and gender. Raised by a single mother in rural North Carolina, McCormick speaks often of hypocritical religious leaders, because he encountered head-on “the judgmental cruelty and fierce hypocrisy of homophobic preachers and self-appointed, so-called ‘family values’ bigots.” Like Smollett, he’s used his brand not just to find followers (especially in the LGBT community), but to also keep them safe and healthy; which is why he’s performed comedy routines at STI clinics and talks frequently about why gay and bi men need to get HIV tests. The first out gay African- American comic to perform at the famed Howard Theater, McCormick also performed at The White House and the Kennedy Center. He has released three acclaimed stand-up comedy concert albums, including his most recent, That B*@&! Better Be Funny, which was considered for a 2014 Grammy nomination for best comedy album. Still, 2017 may also be the year he becomes a household name: it’s hush-hush but insiders say he has a possible development deal in the works. — DA M
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PHOTO CREDIT
Activist RAE LEWIS-THORNTON is outspoken and unrelenting; but, fans say, she's just peddling harsh truths.
A M O U S I N T H E 1 9 9 0 s as “that Black woman with AIDS,” Rae
Lewis-Thornton changed the national conversation around HIV when
she came out on a 1994 cover of Essence magazine. The headline accom-
panying her photo declared, “I’m young, I’m educated, I’m drug-free, and I’m dying of AIDS.” One of the first African-American women to be
open about her status, Lewis-Thornton became a new face of AIDS, one that proved Black women could get HIV even if they didn’t use drugs or have one-night-stands, had gradu-
ated cum laude from Northeastern Illinois University, and had worked on numerous high profile political campaigns (Senator Carol Mosley Braun in 1992, Michael Dukakis presidential campaign in 1988 , and both of Jesse Jackson’s 1980s era presidential bids).
BY JACO B A N D E R S O N - M I N S H A L L + P H OTO G R A P H Y BY F L I K K T H O R N TO N
For many Black women, Lewis-Thornton’s story was—and continues to be—a shocking revelation. After being on the cover of Essence, LewisThornton says she, “became this quasi kind of celebrity with HIV.” Nightline followed her for six months off and on, filming a special report, “Rae’s Story.” In Chicago, she anchored a series of news reports for CBS on HIV that won her an Emmy in 1995. “I was always in the media,” she recalls now. “It was an interesting dichotomy actually, because at one level here I was, an attractive woman, and people were embracing me because my story resonated, especially with Black women. People liked me when they didn’t like their family members. A woman came to me one day and said, ‘You know, it occurred to me that I know more about your life than I know about my brother’s with AIDS.’” Yet, at the same time, there was a backlash to the way her story resonated. “If I am as normal as they are, then they’re at risk too,” she explains. “They think, Oh, my God. This woman is me. This means I can get HIV. That’s when the stereotypical types of questions begin to emerge like, ‘How many men did you have sex with?’” Although Lewis-Thornton often says, “No question is too personal,” she avoids providing a specific number. “All it takes is one,” she says. In all other aspects, the activist is transparent: she’s spoken openly about medication side effects like diarrhea and lipodystrophy. She’s revealed that she had liposuction to remove fatty deposits under her chin. (“I got push back from that,” she says. “But
it opened a door for other people in the clinic to get this same procedure done: for free.”) She talks about sex, dating, and disclosure; she talks about battles with depression, menopause, and aging with HIV. She talks about being a survivor of childhood sexual abuse as “a poor little Black girl born to heroin addicts.” She believes in being open and honest and isn’t afraid to throw in a few F-bombs for emphasis. “I push back in my candor and my honesty in a way that it has [gotten] me a lot of critics,” Lewis-Thornton admits. “Not only in the issue of respectability, but it’s cost me even within the HIV community.” Still, she says, “I fundamentally believe that you cannot save lives with half-truths and misinformation. We set people up for failure when we aren’t honest about what this means. HIV is an exhausting disease to live with. It’s incredibly exhausting. The drug companies don’t want us to talk about that. It’s like, ‘Oh, there she goes again!’ [But] you can’t help people be better if we don’t acknowledge the issues … if we skate over them, if we ignore them, if we say, ‘Oh, it’s just a pill a day.’” Lewis-Thornton says that in many ways she’s “an unpopular AIDS activist. I don’t get pharmaceutical money. I don’t get invited to the big AIDS conferences to speak.” She was invited to a recent Black AIDS Institute roundtable involving Chicago faith leaders and Ambassador-at-large Dr. Deborah Birx, the U.S. (CO N T I N U E D O N PAG E 47 )
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It was quiet enough to hear a whisper when Hamilton star JAVIER MUÑOZ came out as HIV-positive.
B Y D AV I D A RTAV I A
34 | JANUARY / FEBRUARY 2017
CHAD GRIFFITH
TALK ABOUT A REVOLUTION
C O M I N G O U T TA K E S C O U R A G E . It requires you to own yourself, to let go of the secrets that fasten you to shame and fear. It’s a choice to not hide who you are in an effort to please others, even if you’re starring in the biggest Broadway show in history—like Hamilton’s Javier Muñoz is. Muñoz knows what it’s like to come out. After all, he’s done it three times: first, as a gay man; second, as HIV-positive; and finally, as a cancer survivor. To him, secrets are a result of fear and shame, which he sees as the root of stigma. The kind of stigma he is vowing to destroy. “I want to kick the shit out of stigma, and knock it in its fucking teeth,” Muñoz tells Plus. “I’m tired of its existence. It has no place in 2016, going forward from this day on. Period.” Muñoz was the definition of gratitude last fall as GMHC awarded him their Howard Ashman Award, which honors members of the Broadway community whose art and activism has made a difference in the fight against HIV and AIDS. The event brought members of the theater community, many of whom have worked with the man they call “Javi” (pronounced “HAH-vee”) and agreed there is no one more deserving of this year's award. “My definition of an activist is anyone who does something to promote what’s right in the world,” says GMHC’s CEO Kelsey Louie. “In terms of HIV/AIDS it’s someone like Javier Muñoz, who’s using his name and celebrity to raise awareness and to eradicate stigma.” When Muñoz was first diagnosed in 2002, GMHC was the first place he went to find medical treatment and support. He had been in a monogamous relationship with a man in California, and after only two months of deciding to have condomless sex, Muñoz tested positive for HIV. He says initially his anger was all-consuming and it took him years to teach himself not just to accept his poz status, but to really learn how to live with HIV. Anger was a theme plaguing Muñoz during those years, he admits. After being rejected for his honesty by multiple men, he discovered these same guys were having condomless sex with strangers who didn’t even know their status. But after years of soul searching, Muñoz finally discovered that his anger was roooted in fear and shame. Both were at the core of it all, he recalls, a deep pain created and supported by stigma.
ATLANTIC RECORDS/JOAN MARCUS (HAMILTON); GETTY IMAGES/WALTER MCBRIDE (WITH MIRANDA)
Hamilton on Broadway
Stigma is an invisible killer, Muñoz argues. It holds us in place by making us afraid and limiting our potential. Today, he sees that same kind of stigma around PrEP, the HIV-prevention treatment. “It’s the same stigma we had to deal with this entire time. It’s rooted in fear and shame. What I hope to be is a face, an energy, and a way for this generation and generations to come to see that it is not the end of anything.” Muñoz says he's been fortunate enough not to experience stigma in the workplace. “As I've primarily worked in theatre I’ve always been surrounded and supported by community that has been fearless in love, protection, and compassion for fellow artists living with HIV and AIDS.” It’s hard to believe the man praised by one New York Times critic as “sexy, with a penetrating stare, and a Don Juan smile” never dreamed this kind of life for himself growing up in Brooklyn. In fact, he had his eyes set on a different set of stars. “I wanted to be an astrophysicist when I was a kid,” he recalls. “I did not discover theater until I was 13. [Fame] was far from anything I imagined as a child. I was totally a science geek and I wanted to be in space exploring the stars.” For nearly a decade, Muñoz has been part of Hamilton creator Lin Manuel Miranda’s so-called “Rat Pack,” beginning first as an understudy on In The Heights. With Hamilton, he says, the two developed the role together. “We were in the room creating a role together and our heads had to be in the game and that takes 100 percent from everyone involved.” Miranda made a surprise appearance at the GMHC event and wowed the crowd by singing a song written for Muñoz’s In The Heights character, which was later taken out of the production. Muñoz’s professionalism and determination to bring love and joy to those around him has never gone unnoticed, especially to his friend, Orange is the New Black star Uzo Aduba, who also made an appearance to honor him at the event. The two worked together years ago, and Muñoz shared his positive HIV status with her privately. “As I watched you work and as I watched you as a friend, at no point did you ‘become’ your status,” Aduba told Muñoz at the event. “You’re committed
Muñoz with Lin Manuel Miranda
to living a fully present, active life, and it’s what illuminates your activism. Your love, loyalty, joy, and true passion as an artist is what makes you such a remarkable human being, and the world is better for knowing you.” Through friends like Aduba, Muñoz has learned that “HIV doesn't just affect the individual; HIV affects all of the individual’s loved ones. No one wants to see someone they love suffer or unable to find fulfillment and joy. By openly loving and supporting someone in your life living with HIV or AIDS you become an ally. That kind of compassion makes us all HIV. We are all facing this together." Again, coming out takes courage. Using your celebrity to show the world you can be a gay man living with HIV, and be proud of it, is seldom seen in today’s fabric of stardom. As Muñoz says, the journey is never easy. What got him through most of it was his willingness to be patient. “Patience with myself [and] patience that treatment or medicine is going to work eventually. Part of that patience is a choice, and that’s faith.” Still, even giants like Muñoz have bad days. So what does he do when he’s feeling low? Without batting an eyelash he smiles and says, “I call my mom.”
HIVPLUSMAG.COM | 35
TASP Racial bias isn’t just a police problem; it’s also a problem among healthcare professionals and gay Black men are bearing the brunt of it. I F YO U ’ R E A G AY B L AC K M A N
living with HIV in America, finding a quality doctor is difficult. Racial bias lingers under the radar whether we see it or not, but the National Alliance of State and Territorial AIDS Directors is trying to stop that with their new online training platform, HisHealth.org. The site helps doctors, nurses, and other medical professionals unlearn racial bias and elevate the quality of healthcare for African-American men who have sex with men. Those already living with HIV also face healthcare barriers, Omoro F. Omoighe, an associate director with NASTAD, says: “For some young, Black gay men who are new to healthcare and grappling with a new HIV diagnosis, it may be challenging to speak up and advocate for themselves and say ‘I actually don’t quite understand what you mean by viral load’ or ‘I don’t quite understand the treatment that you are recommending.’ Healthcare providers need be aware of these fears and knowledgeable about what Black gay men are going through so they can better address their healthcare needs.” Led primarily by physicians who are African-American gay men themselves, HisHealth provides accredited, expert-led continuing education courses that count towards the credits medical professionals already need to maintain their licenses. It also explores various models of care, including Project Silk and Connec ting Resources for Urban Sexual Health. It can provide access to 36 | JANUARY / FEBRUARY 2017
resources that support the delivery of high quality, culturally-affirming healthcare services for Black gay and bisexual men. HisHealth offers hour-long, selfpaced modules covering topics like PrEP, linkage to care, whole health assessments, and transgender health. “Many patients talk about having to educate their healthcare provider about their sexual health needs,” Omoighe explains. “If a patient is educating their doctor about their sexual … behaviors, the provider is learning in real time,” which makes it hard for them to offer quality advice. Omoighe believes doctors will find that going the extra mile pays off in the end. “Minding the communication gap and being comfortable working with patients who love and live differently than you do is going to be completely transformative with regard to the quality of care that is offered to these patient communities.” Less than 10 percent of gay and bi men have used PrEP before, and outreach often skips lower economic neighborhoods.
— DAV I D A R TAV I A
SHUTTERSTOCK
CAN WE STOP THE DOCTOR BIAS?
Why? “Research shows that implicit bias stops many doctors from providing high-quality care to Black Americans,” says Terrance Moore, deputy executive director at NASTAD. “Add to that a lack of understanding about the sexual healthcare needs of LGBT patients, and many men I know would rather stay home. That’s why this new tool is so important—we can help doctors fight implicit bias and provide better care.” A 2014 study by the Perception Institute found evidence that bias is a pervasive issue within the medical field. Researchers discovered that non-Black doctors often treat pain less aggressively for their African-American patients. Earlier this year, another study , this one by a Yale researcher, suggested that non-Black doctors were also less engaged with their Black patients. Add to that many healthcare providers’ hesitance in starting frank discussions about sexual specifics—particularly those involving anal sex—and Black gay and bi men are doubly disadvantaged. “For many Black gay men, their care experiences are marred by a palatable sense of uneasiness and discomfort that some doctors and nurses have discussing their preferred sexual practices, desires, and behaviors,” Omoighe says. “The confluence of these factors can translate into subpar healthcare and increased risk for HIV transmission. If your doctor is uncomfortable and or unfamiliar with your sexual health needs, they will be unable to offer their patients adequate preventative care. HisHealth.org is the first step towards addressing this critical communication gap.”
YOU’RE PROBABLY GETTING THE WRONG ANTIBIOTIC— BE WORRIED
FIVE TIPS TO HELP YOU STAY ON TRACK WITH YOUR MEDICATIONS It’s estimated that 50 percent of people who take medications do not take them as prescribed. Here are a few tips to help you make sure you get the most out of your prescriptions.
SHUTTERSTOCK
AS K A N E X P E R T When taking prescription medications or over-the-counter drugs, ask your healthcare provider or pharmacist about any concerns you may have. Questions might include dosage, expiration dates, proper storage, potential side effects, or anything else that could lessen your chances of taking your medications correctly and effectively. Make sure your healthcare provider or pharmacist knows the full list of prescriptions, over-the-counter medication, and/or herbal supplements you are taking; to ensure there are no dangerous drug interactions or side effects. D O N ’ T D E V I AT E F R O M YO U R R X Not taking your medication as prescribed can lead to adverse side effects, prolonged illness, drug resistant infections, or the need for additional medications. Stoping your medication can also be dangerous. Your health plan, or the company who makes your medication, may offer a “medication adherence” program, which provides you with support, tools, and resources. Some even include access to a 24/7 clinical coach who can help you stay on track with your medication schedule and help you overcome any obstacles you might have with taking your medicine regularly.
F I N I S H YO U R P R E S C R I P T I O N Even if you think you do not need the medication anymore or you are feeling better, follow the instructions given by your healthcare provider and don’t stop taking the meds without talking to your doctor first. Prescriptions do expire, so “saving” the remainder for later use can be dangerous. If refills are needed, set up automatic refills or personal reminders so you never run out or miss a dose. K N OW T H E S I D E E F F E C TS Knowing the potential side effects of each medication you are taking allows you to be aware of changes in your health or how you are feeling. If you do experience a side effect, contact your healthcare professional immediately. MAKE AN APPOINTMENT WITH YO U R S E L F Taking your medications as prescribed and at the times recommended by your healthcare professional is important to the effectiveness of your treatment. Set a reminder on your phone or computer calendar to prompt you to take your medication. Use a daily or weekly pill organizer to ensure you take the right medications at the right time on the right day. By establishing a routine with your medications, you are less likely to miss a dose. —J E N N I F E R B O N H A M Jennifer Bonham is a corporate director at Envolve (Envolvehealth.com), a company that offers a wide range of healthcare solutions.
According to a new study, nearly 44 million antibiotic prescriptions a year are written for ear and sinus infections, or sore throats. Fiftytwo percent of the time, those prescriptions are for the wrong antibiotics; and a third go to people who don’t even need them! This is a problem. While infectious diseases were once obliterated by antibiotics like penicillin, the drugs are now everywhere, including in our food. As a result, those illness causing pathogens have become drug resistant “superbugs” that now kill 23,000 people a year. According to the Centers for Disease Control and Prevention, over 2 million people are infected by drug-resistant germs every year. Why are docs prescribing the wrong drugs? Patient demand. That’s what researchers from Pew Charitable Trusts, the CDC, and the University of Utah (among others) found. “We have seen studies that show doctor prescribing is influenced by those types of patient pressures and expectations for receiving antibiotics,” Dr. David Hyun, an infections disease specialist at Pew, told NBC. If you have strep throat or a lingering sinus infection, antibiotics may help, but most sore throats and ear infections are caused by viruses—and antibiotics only treat bacterial infections. If an antibiotic is prescribed, it should be a basic one like amoxicillin. But that’s not what’s happening either, especially when patients ask for a specific antibiotic. The lesson? Stop pressuring doctors to prescribe specific drugs. And avoid superbugs by taking antibiotics sparingly. — DA
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NEW YEAR, NEW YOU Our expert answers your questions
I’ve been lifting weights five or six days a week for the past year, but instead of building muscle I’m feeling tired and unmotivated. Is it possible to work out too much? Yes. You are probably lifting weights too frequently and inadvertently hampering your muscle growth. It’s called “overtraining,” and it involves training too hard and too often without giving your body enough time to rest in between. The effects usually show up as fatigue and extreme muscle soreness. Sometimes, as in your case, the signs are even more serious: depression, low energy, insomnia, loss of appetite, and worst of all, loss of lean body mass. Cut back on your training and make sure you’re getting adequate rest in between workouts. A trainer can help you schedule what to do each day. Also, take a hard look at everything you’re eating—or not eating—to make sure you’re getting enough macronutrients (carbs, fat, and protein).
I’ve been feeling down since my doctor told me to drop exercises like lunges, squats, or deadlifts
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because of degenerating discs in my spine. How do I keep my body—especially, my butt—in shape? While the primary touchstone for people with HIV is weight training, cardiovascular exercise is probably the best natural medicine for depression, and regular cardio results in feelings of self-mastery and accomplishment. Yoga is also an option for you, allowing you to connect with your body while quieting your mind. Many gyms offer classes that target the glutes. Consider joing a spin classes, or doing exercises with your own bodyweight, too. It’s been months since I’ve been in the gym, and I’m finding it hard to go back. How can I break this cycle? Stopping exercise enhances feelings of isolation, anxiety, and depression.When you’re under a lot of stress, remember exercise is a gift that you give yourself. The best thing you can do for your physical and mental health is to recommit to a more active lifestyle. The mood-enhancing benefits of exercise and its effects on the immune system are well documented and more durable than once thought, lasting up to 12 hours after the workout ends. Get outside. Change your environment. Take advantage of your surroundings. Go for a brisk walk around the neighborhood, swim at a local pool, hike a new trail, take a self-defense class, join a team, or sign up for the AIDS Walk. Many AIDS Walks offer pre-walk trainings where groups get together and walk increasing amounts of distance each week, working up to the big day.
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I’m worried about wasting and body-fat redistribution. I’ve heard that taking glutamine and creatine can help. Do these sports supplements have any potential interactions with antiretroviral therapy? Unfortunately, research is scant and inconclusive. Supplementing your diet with the amino acid L-glutamine has been shown to fight wasting and is used to counteract chemotherapy side effects like diarrhea, neuropathy, and muscle and joint pains. Creatine may also have a place at the table, especially for vegetarians, but your muscles can only retain a certain amount of creatine; taking more won’t raise levels higher. While no adverse effects have been reported with glutamine or creatine use, other supplements such as Saint-John’s-wort have significant interactions with some HIV meds, and illustrate the complexity of adding even “natural” substances to an antiretroviral regimen. It’s best to communicate with your doctor about all the supplements you’re using. That way, he or she can take them into account if you develop any side effects or if your viral load response is off. You might also want to check out the Plus Treatment Guide, which includes information about potential drug interactions.
My trainer told me that doctors sometimes prescribe testosterone for people with HIV. Would that help me build muscle faster? Yes, raising your testosterone levels can increase lean body mass, reduce fat, and increase energy. However, the long-term risks are largely unknown and, as the Harvard Men’s Health Watch, points out, you should be particularly cautious if you have cardiac or prostate issues. Also, once you start taking hormone supplements there’s a chance your body may stop producing testosterone naturally. Instead of rushing into it, talk with your doctor and get blood work to check on your natural levels. You can also enhance your testosterone levels by eating a balanced diet, taking a multivitamin, getting enough sleep, and avoiding excessive caffeine, alcohol, and nicotine. Ask your trainer to use more multiple joint exercises (e.g., lunge, bench press, deadlift, clean, squat, pull-up) as these can play a role in higher levels of post-workout testosterone. If your natural level of testosterone turns out to be below the normal reference range, there are a variety of choices including patches, gels, creams, injections—even implants. Unfortunately, not all insurance companies cover all options.
One of my friends raves about taking human growth hormone. Can you tell me more about it? Do I need a prescription? Human growth hormone is just that: a hormone that stimulates growth and reproduction of human cells. It’s responsible for a variety of functions in the body, most notably the increase in height during adolescence. It’s a controlled substance available by doctor’s prescription and is sometimes prescribed for people with HIV who are suffering from wasting syndrome or lipodystrophy (the redistribution of fat). In clinical trials, men receiving a low dose of human growth hormone gained lean body mass, experienced reductions in abdominal fat, and had lower triglycerides. Reductions in ‘buffalo humps’ have also been reported, but potential side effects include breast development in men, skin cancers, gastrointestinal bleeding, and inflammation of the arteries. There’s more reason to be cautious: while HGH may also work as an immune-based therapy to help the body produce new T cells, it’s been shown to increase HIV reproduction in the lab. Therefore, growth hormone must always be used in combination with an anti-HIV drug regimen that’s able to keep your viral load undetectable. People who have an active form of cancer must never use it. For these reasons, it’s essential to only use HGH with a doctor’s supervision. — SA M PAG E Sam Page is a fitness trainer and wellness expert in Los Angeles. Twitter: @SamPageFitness, Facebook: SamPageLA. Additional research by Savas Abadsidis.
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Do I need to be worried about picking up bacteria like methicillin-resistant staphylococcus aureus or other forms of staph at gyms? Yes. According to the Centers for Disease Control and Prevention, HIV-positive people may be at risk for more severe illnesses from MRSA than the gen-
eral population. Treatments may be invasive, take days to administer, and are not always successful. As these infections become increasingly resistant to treatment they become harder to get rid of. To protect yourself, wash your hands frequently. Wash your whole body with soap and running water. Keep fingers out of your nose. Protect any areas of broken skin, since this is one common way for the bacteria to get inside you. Use a towel during your workout to create a barrier between your skin and anything it might touch, like the weight bench. After your workouts, wash your towels in hot water and dry them in a hot dryer. Before and after your workout, make use of hand-sanitizer dispensers, alcohol-based sprays, or wipes for equipment.
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SOOTHE OPERATOR There’s a reason celebrities love this on-demand massage app.
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I M OV E D TO the boonies about
three years ago, and while I love living in the California desert (70 degree days in December), I can’t seem to get delivery to come to my door: not even dinner. Imagine my surprise when Soothe, the ultra-popular massageon-demand app, announced they were heading my way. After hearing people in Los Angeles (including Sharon Stone) rave about it, I could finally embrace it myself. For the record: I love being massaged. I have fibromyalgia and myofascial pain syndrome so my primary, rheumatologist, and pain management doctors have each recommended regular massage. Getting massaged is one of the few things on this planet that I can afford (at least occasionally) that helps relieve my chronic pain. A day without massage can be a day of agony. I’m not alone. Chronic pain has reached epidemic levels and peo-
ple with HIV are far from immune. In fact, according to a 2012 report in Pain Physician Journal, chronic pain “has increased incidence in HIV patients, with multiple HIV-related conditions raising risks of pain disorders.” Studies have estimated the prevalence of pain among those living with HIV to be as high as 90 percent. Rand’s HIV Cost and Services Utilization Study (the largest survey of its kind) found that 67 percent of people living with HIV in the U.S. reported experiencing at least some pain in the previous week. Peripheral neuropathy impacts over 40 percent of people living with HIV, and, according to the Pain Physician Journal, poz folks also frequently experience headaches, abdominal pain, joint pain, pain from Kaposi sarcoma, and myofascial pain. Researchers have also found that pain is more common in women but,
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“while pain is reported to be less common and less severe in AfricanAmerican HIV patients … a recent study suggests that these patients are more likely to be suspected by health care providers of opioid misuse. It has been suggested that both women and non-White patients may be at higher risk for under-treatment of their pain.” In the 16 years since being diagnosed with fibro and MPS, I’ve found only a handful of treatments that successfully manage it: prescription opioids, medical cannabis, hot salt water soaks, and massage. When we moved out to the sticks, I had to leave my massage therapist behind and have gotten so desperate to find a new one, I even stopped at new place in town that advertised “1-hour Oriental massage.” There were many female masseuses, but no female clients. I may have been willing to pay for a happy ending—as it appeared was customary—but the women sent me packing before I could disrobe. Thankfully, Soothe has saved me. The app takes away all the ambiguity and the fear of accidently walking into another sex worker storefront. Instead, all it took was answering a few simple questions to request a fully licensed massage therapist. Leilani arrived on time, set up where I directed her, and proceeded to give me the best deep tissue massage I’ve had in a long time. Soothe’s recent expansions takes the on-demand app to the Palm Springs and Inland Empire regions of California, as well as Toronto, Canada. By the beginning of 2017, Soothe’s 7,000-plus licensed massage therapists will be available in 50 cities (and several countries) including: Los Angeles, the San Francisco Bay Area, San Diego, San Jose, Santa Barbara, California; New York, London, Atlanta, Austin, Baltimore, Boston, Chicago, Dallas, Denver, Fort Worth, Ft. Lauderdale, Honolulu, Houston, Indianapolis, Las Vegas, Long Island, Memphis, Miami, Milwaukee, Minneapolis, Nashville, New Orleans, Northern New Jersey, Norfolk/Virginia Beach, Oklahoma City, Orlando, Philadelphia, Phoenix, Salt Lake City, Seattle, St. Louis, and Scottsdale, Arizona; Toronto and Vancouver, Canada; Washington, D.C.; Charlotte, North Carolina; Portland, Oregon; Cincinnati, Columbus, and Cleveland, Ohio; and Sydney and Melbourne, Australia. All that growth and the ability to book on your phone, draws apt comparisons to Uber. Booking, paying, and tipping is taken care of via credit card ahead of time, so the awkward money exchange is out of the way. Soothe offers deep tissue, Swedish, sports, and prenatal massages daily between the hours of 8 a.m. and midnight. In addition to the type and length of massage, you choose the gender of your therapist, and prices are reasonable: $99 for 60 minutes, $139 for 90 minutes, and $169 for 120 minutes. (Yes, a two-hour massage is as wonderful as it sounds.) CEO Merle Kauffman created Soothe in 2013, while attending Harvard Business School. He was traveling frequently, and found it difficult to schedule a massage appointment outside standard business hours. What started as a solution to his own problem, has grown into a flourishing business, with the number of certified massage therapists on the platform having more than doubled since last year. Therapists I spoke with (two women and a gay man) all said they love the gig economy aspect of working for Soothe—and the LGBTQ friendliness. I asked Jeff Bishop, the gay director of operations at Soothe—who lives in nearby Palm Desert—about the recent expansion. “Palm Springs is an ideal location for Soothe as it is not only an amazing place to live, but one of the premiere LGBT resort destinations in the world,” he says. In fact, Palm Springs’s LGBT residents make up around half the city’s permanent population, the average age of residents is over 50, and the percentage of gay and bi residents who are living with HIV is relatively high. That’s one reason why Bishop is quick to reassure poz locals and visitors alike that Soothe bodyworkers won’t stigmatize them. “Our therapists are rigorously trained and vetted to ensure that they are able to work with people from all walks of life including senior citizens and people living with HIV—they are true healers,” he says, adding, “Those living with HIV can expect to see many benefits from receiving massage therapy regularly. These include a reduction in stress and anx-
iety and even increasing NK cell cytotoxicity and T-cells, which can be beneficial to one’s health when HIV-positive.” Certainly you don’t need to be LGBT or HIV-positive to enjoy a massage. It’s been shown to provide health benefits for everyone from athletes to factory workers to pregnant women. Having celebrities tout Soothe is raising demand for the app—from both clients and would-be employees. (My massage therapist, Leilani, signed on after hearing Ellen DeGeneres talk about it on her TV show). “LGBT folks are definitely known for being first adopters and brand advocates,” Bishop says. “So we are really excited for them to be able to try Soothe out and share it with their friends and family. Similarly, LGBT folks tend to be very conscious of their bodies and their overall health—in terms of what they are eating, how often they are exercising, and so forth—so it makes sense for them to embrace massage from a health benefits perspective, and add massage to their active lifestyle.” It only took one massage for me to fully embrace Soothe. More than that, I suddenly can’t live without it. Thankfully, it’s expanding quickly. I’m already planning to schedule in Soothe sessions as I travel for work this year.
—DIANE ANDERSON-MINSHALL
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D A I LY D O S E BY TYLER CURRY
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DEAR GAY MEN: YOUR FRIEND IS HIV-POSITIVE IT DOESN’T MATTER WHO YOU ARE OR WHERE YOU HAIL FROM, IF YOU ARE
B E F O R E I S P R O U T E D out of the closet as a little gay sapling, my mother had never met a single homosexual person in her life. And in the suffocating southern Christian confines of Texas, her limited perception was open to the most horrific creative interpretation. The nightmares of evil drag queens and insidious perverts quickly faded away, however, once her son told her that he liked boys. The majority of gay men know how it feels to secretly live in the presence of someone who is blindly afraid of you, yet that is exactly what we do to HIVpositive men. It is because of this that I write an open letter to gay men young and old: Your friend is living with HIV. It doesn’t matter who you are or where you hail from, if you are a man who kisses other men, someone you know is HIVpositive. Hopefully, this is already yesterday’s news because you live in a collective space where your friends are not afraid to discuss their love and sex lives, regardless of their status. But if you care to argue that this is a false narrative, then you may be creating barriers for your HIV-positive friends without even knowing it. This isn’t just a hindrance to their mental health, it is also a risk to your own HIV-negative status. If you don’t acknowledge the reality that your friends may be living with HIV, you probably think that you’ve never slept with an HIV-positive person either. In the first six months after my diagnosis, I was petrified to tell my best friend about my status. As much as I knew he wouldn’t judge me or toss our friendship aside, something he previously said kept ringing in my ears.
“I would never date someone with HIV. I just don’t think I could get over it.” A world where my best buddy would reject someone just like me was a world I could live without. Yet I tucked it inside and hid something from my friend to avoid any stigma from someone I loved. When I did tell him my status and the reason for my hesitation, he was immediately overcome with unquestionable support and complete remorse. And just like anyone who made a judgment before getting to know someone, his benign HIV stigma has become undetectable. Although most days I do feel like a rainbow unicorn, my story and my status is nothing unique. If you are a gay man, or any other person who knows more than a handful of gay or bi men, then you know a person with HIV. Instead of trying to figure out who it could be, think about how you would feel if one of your closest friends was judged, rejected, and ridiculed for their status. How would you feel if one of your friends is remaining silent because he feels you might judge and reject him as well? HIV isn’t exclusive to the LGBT community, but it is the backbone of our legacy of tragedy and strength. Today, HIV doesn’t have to rob a person of anything in their life, but only if they are surrounded by an educated and loving community that understand a disease is not a personality characteristic or flaw. It’s just another thing to overcome, and the LGBT community overcomes our struggles together. Be a part of that community. Be a friend, a lover, and an ally to people with HIV.
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A MAN WHO KISSES OTHER MEN, SOMEONE YOU KNOW IS HIV-POSITIVE.
WHAT IS ODEFSEY®?
What are the other possible side effects of ODEFSEY?
ODEFSEY is a 1-pill, once-a-day prescription medicine used to treat HIV-1 in people 12 years and older. It can either be used in people who are starting HIV-1 treatment, have never taken HIV-1 medicines before, and have an amount of HIV-1 in their blood (“viral load”) that is no more than 100,000 copies/mL; or in people who are replacing their current HIV-1 medicines and whose healthcare provider determines they meet certain requirements. These include having an undetectable viral load (less than 50 copies/mL) for 6 months or more on their current HIV-1 treatment. ODEFSEY combines 3 medicines into 1 pill taken once a day with a meal. ODEFSEY is a complete HIV-1 treatment and should not be used with other HIV-1 medicines.
Serious side effects of ODEFSEY may also include: • Severe skin rash and allergic reactions. Skin rash is a common side effect of ODEFSEY. Call your healthcare provider right away if you get a rash, as some rashes and allergic reactions may need to be treated in a hospital. Stop taking ODEFSEY and get medical help right away if you get a rash with any of the following symptoms: fever, skin blisters, mouth sores, redness or swelling of the eyes (conjunctivitis), swelling of the face, lips, mouth, or throat, trouble breathing or swallowing, pain on the right side of the stomach (abdominal) area, and/or dark “tea-colored” urine. • Depression or mood changes. Tell your healthcare provider right away if you: feel sad or hopeless, feel anxious or restless, have thoughts of hurting yourself (suicide) or have tried to hurt yourself. • Changes in liver enzymes. People who have had hepatitis B or C or who have certain liver enzyme changes may have a higher risk for new or worse liver problems while taking ODEFSEY. Liver problems can also happen in people who have not had liver disease. Your healthcare provider may do tests to check your liver enzymes before and during treatment with ODEFSEY. • Changes in body fat, which can happen in people taking HIV-1 medicines. • Changes in your immune system. Your immune system may get stronger and begin to fight infections. Tell your healthcare provider if you have any new symptoms after you start taking ODEFSEY. • Kidney problems, including kidney failure. Your healthcare provider should do blood and urine tests to check your kidneys. Your healthcare provider may tell you to stop taking ODEFSEY if you develop new or worse kidney problems. • Bone problems, such as bone pain, softening, or thinning, which may lead to fractures. Your healthcare provider may do tests to check your bones.
ODEFSEY does not cure HIV-1 infection or AIDS. To control HIV-1 infection and decrease HIV-related illnesses, you must keep taking ODEFSEY. Ask your healthcare provider if you have questions about how to reduce the risk of passing HIV-1 to others. Always practice safer sex and use condoms to lower the chance of sexual contact with body fluids. Never reuse or share needles or other items that have body fluids on them.
IMPORTANT SAFETY INFORMATION What is the most important information I should know about ODEFSEY? ODEFSEY may cause serious side effects:
• Buildup of an acid in your blood (lactic acidosis), which
is a serious medical emergency. Symptoms of lactic acidosis include feeling very weak or tired, unusual muscle pain, trouble breathing, stomach pain with nausea or vomiting, feeling cold (especially in your arms and legs), feeling dizzy or lightheaded, and/or a fast or irregular heartbeat. • Serious liver problems. The liver may become large and fatty. Symptoms of liver problems include your skin or the white part of your eyes turning yellow (jaundice); dark “tea-colored” urine; loss of appetite; light-colored bowel movements (stools); nausea; and/or pain, aching, or tenderness on the right side of your stomach area. • You may be more likely to get lactic acidosis or serious liver problems if you are female, very overweight, or have been taking ODEFSEY or a similar medicine for a long time. In some cases, lactic acidosis and serious liver problems have led to death. Call your healthcare provider right away if you have any symptoms of these conditions.
• Worsening of hepatitis B virus (HBV) infection. ODEFSEY
is not approved to treat HBV. If you have both HIV-1 and HBV and stop taking ODEFSEY, your HBV may suddenly get worse. Do not stop taking ODEFSEY without first talking to your healthcare provider, as they will need to monitor your health.
Who should not take ODEFSEY? Do not take ODEFSEY if you take: • Certain prescription medicines for other conditions. It is important to ask your healthcare provider or pharmacist about medicines that should not be taken with ODEFSEY. Do not start a new medicine without telling your healthcare provider. • The herbal supplement St. John’s wort. • Any other medicines to treat HIV-1 infection.
The most common side effects of rilpivirine, one of the medicines in ODEFSEY, are depression, trouble sleeping (insomnia), and headache. The most common side effect of emtricitabine and tenofovir alafenamide, two of the medicines in ODEFSEY, is nausea. Tell your healthcare provider if you have any side effects that bother you or do not go away.
What should I tell my healthcare provider before taking ODEFSEY? • All your health problems. Be sure to tell your healthcare
provider if you have or have had any kidney, bone, mental health (depression or suicidal thoughts), or liver problems, including hepatitis virus infection. • All the medicines you take, including prescription and overthe-counter medicines, vitamins, and herbal supplements. Other medicines may affect how ODEFSEY works. Keep a list of all your medicines and show it to your healthcare provider and pharmacist. Ask your healthcare provider if it is safe to take ODEFSEY with all of your other medicines. • If you are pregnant or plan to become pregnant. It is not known if ODEFSEY can harm your unborn baby. Tell your healthcare provider if you become pregnant while taking ODEFSEY. • If you are breastfeeding (nursing) or plan to breastfeed. Do not breastfeed. HIV-1 can be passed to the baby in breast milk.
Ask your healthcare provider if ODEFSEY is right for you, and visit ODEFSEY.com to learn more. You are encouraged to report negative side effects of prescription drugs to the FDA. Visit www.fda.gov/medwatch, or call 1-800-FDA-1088.
Please see Important Facts about ODEFSEY including important warnings on the following page.
ODEFSEY does not cure HIV-1 or AIDS.
SHOW YOUR
RADIANCE ODEFSEY is a complete, 1-pill, once-a-day HIV-1 treatment for people 12 years and older who are either new to treatment and have less than 100,000 copies/mL of virus in their blood or people whose healthcare provider determines they can replace their current HIV-1 medicines with ODEFSEY.
IMPORTANT FACTS This is only a brief summary of important information about ODEFSEY® and does not replace talking to your healthcare provider about your condition and your treatment.
(oh-DEF-see) MOST IMPORTANT INFORMATION ABOUT ODEFSEY
POSSIBLE SIDE EFFECTS OF ODEFSEY
ODEFSEY may cause serious side effects, including:
ODEFSEY can cause serious side effects, including:
•
•
•
Buildup of lactic acid in your blood (lactic acidosis), which is a serious medical emergency that can lead to death. Call your healthcare provider right away if you have any of these symptoms: feeling very weak or tired, unusual muscle pain, trouble breathing, stomach pain with nausea or vomiting, feeling cold (especially in your arms and legs), feeling dizzy or lightheaded, and/or a fast or irregular heartbeat.
•
Severe liver problems, which in some cases can lead to death. Call your healthcare provider right away if you have any of these symptoms: your skin or the white part of your eyes turns yellow (jaundice); dark “tea-colored” urine; loss of appetite; light-colored bowel movements (stools); nausea; and/ or pain, aching, or tenderness on the right side of your stomach area.
•
Worsening of hepatitis B (HBV) infection. ODEFSEY is not approved to treat HBV. If you have both HIV-1 and HBV, your HBV may suddenly get worse if you stop taking ODEFSEY. Do not stop taking ODEFSEY without first talking to your healthcare provider, as they will need to check your health regularly for several months.
You may be more likely to get lactic acidosis or severe liver problems if you are female, very overweight, or have been taking ODEFSEY or a similar medicine for a long time.
• • • •
• •
Those in the “Most Important Information About ODEFSEY” section. Severe skin rash and allergic reactions. Depression or mood changes. Changes in liver enzymes. Changes in body fat. Changes in your immune system. New or worse kidney problems, including kidney failure. Bone problems.
The most common side effects of rilpivirine, one of the medicines in ODEFSEY, are depression, trouble sleeping (insomnia), and headache. The most common side effect of emtricitabine and tenofovir alafenamide, two of the medicines in ODEFSEY, is nausea. These are not all the possible side effects of ODEFSEY. Tell your healthcare provider right away if you have any new symptoms while taking ODEFSEY. Your healthcare provider will need to do tests to monitor your health before and during treatment with ODEFSEY.
BEFORE TAKING ODEFSEY ABOUT ODEFSEY •
ODEFSEY is a prescription medicine used to treat HIV-1 in people 12 years of age and older who have never taken HIV-1 medicines before and who have an amount of HIV-1 in their blood (“viral load”) that is no more than 100,000 copies/mL. ODEFSEY can also be used to replace current HIV-1 medicines for some people who have an undetectable viral load (less than 50 copies/ mL), have been on the same HIV-1 medicines for at least 6 months, have never failed HIV-1 treatment, and whose healthcare provider determines that they meet certain other requirements.
•
ODEFSEY does not cure HIV-1 or AIDS. Ask your healthcare provider about how to prevent passing HIV-1 to others.
Do NOT take ODEFSEY if you: • Take a medicine that contains: carbamazepine (Carbatrol®, Epitol®, Equetro®, Tegretol®, Tegretol-XR®, Teril®), dexamethasone (Ozurdex®, Maxidex®, Decadron®, Baycadron™), dexlansoprazole (Dexilant®), esomeprazole (Nexium®, Vimovo®), lansoprazole (Prevacid®), omeprazole (Prilosec®, Zegerid®), oxcarbazepine (Trileptal®), pantoprazole sodium (Protonix®), phenobarbital (Luminal®), phenytoin (Dilantin®, Dilantin-125®, Phenytek®), rabeprazole (Aciphex®), rifampin (Rifadin®, Rifamate®, Rifater®, Rimactane®), or rifapentine (Priftin®). •
Take the herbal supplement St. John’s wort.
•
Take any other HIV-1 medicines at the same time.
Tell your healthcare provider if you: • Have or have had any kidney, bone, mental health (depression or suicidal thoughts), or liver problems, including hepatitis infection. • Have any other medical condition. • Are pregnant or plan to become pregnant. • Are breastfeeding (nursing) or plan to breastfeed. Do not breastfeed if you have HIV-1 because of the risk of passing HIV-1 to your baby. Tell your healthcare provider about all the medicines you take: • Keep a list that includes all prescription and over-the-counter medicines, vitamins, and herbal supplements, and show it to your healthcare provider and pharmacist. • Ask your healthcare provider or pharmacist about medicines that should not be taken with ODEFSEY.
HOW TO TAKE ODEFSEY • •
ODEFSEY is a complete 1-pill, once-a-day HIV-1 medicine. Take ODEFSEY with a meal.
GET MORE INFORMATION •
• •
This is only a brief summary of important information about ODEFSEY. Talk to your healthcare provider or pharmacist to learn more. Go to ODEFSEY.com or call 1-800-GILEAD-5 If you need help paying for your medicine, visit ODEFSEY.com for program information.
ODEFSEY, the ODEFSEY Logo, GILEAD, and the GILEAD Logo are trademarks of Gilead Sciences, Inc., or its related companies. All other marks referenced herein are the property of their respective owners. Version date: March 2016 © 2016 Gilead Sciences, Inc. All rights reserved. ODEC0026 06/16
FLIKK THORNTON
(CO N T I N U E D F R O M PAG E 3 3 )
Global AIDS Coordinator who oversees the implementation of the President’s Emergency Plan for AIDS Relief (PEPFAR). Lewis-Thornton isn’t sure it went well. “I say things that aren’t popular. I say things that make me come across looking as anti- something that I’m not.” In this case, she acknowledges, “You say something like that at a meeting and everybody’s looking at you like you fucking—like you’re antigay, you hate all gay men.” Actually, Lewis-Thornton—who says her best friend is a gay man—has a long track record of being LGBT friendly. Among her fans is Tracy Baim, the publisher of Chicago’s LGBTQ paper, Windy City Times, who says Lewis-Thornton, “has always been very inclusive in her work, never shying away from the intersections of this disease, including its impact on the LGBT community.” So, what did Lewis-Thornton say? “This is a town hall meeting talking about how we address stigma in HIV around the church. To me that’s a separate topic than: How do we address homophobia among Black preachers and Black churches? Are they related in some way? Yes. It’s related because Black gay men who are ostracized in their families and in their churches end up—if they’re not on the down-low, they end up with low self-esteem, and end up living a life where they put themselves at risk for HIV. ” “So yes,” Lewis-Thornton continues, “if the African-American community was conducive to having an open and honest discussion about Black gay men and creating space for [out] Black gay [men] in our community, it would probably help with some of the self-esteem issues. Which will probably limit some of the HIV.” But when it comes to talking about HIV stigma in church, Lewis-Thornton says, “Eighty percent of every Black church is female. What about the woman sitting in the church with HIV? How do we get to her pastor? We need to meet preachers where they’re at, not where we want them to be. I’m a seminary trained, licensed, ordained minister. You cannot push back on a pastor’s theology. But if you went to that same pastor and said, ‘HIV is an issue in the Black community. HIV is an issue in your area. Can we come and test?’ They’re gonna say yes! Now can you bring condoms? No. But you can test. I’ve never had a Black preacher say ‘No’ to me [and] I have tested in churches across this country.” Lewis-Thornton recognizes that what she says makes some people uncomfortable: “The way I unpack stuff, it unnerves people. It has not gotten
You cannot save lives with half-truths... me invited to places, and it’s OK. Because guess what? My niche is my niche. What I’m able to do and the lives that I’m able to touch, those are the lives that I’m gonna be able to touch. Those who can hear me will hear me.” Now 54, Lewis-Thornton has been HIV-positive for over three decades, and living with AIDS for two. In that time she’s also become an ordained minister and a businesswoman with an expanding line of jewelry (worn by the likes of Phadrea Parks and Dionne Warwick). “Seven years ago I launched a line of bracelets because I wanted to make the color red and AIDS awareness exciting,” Lewis-Thornton explains. “I’m now expanding the bracelet business to include my hand-knitted accessories. A part of that will always be AIDS awareness. I have the red collection in bracelets, which is sort of like Bono’s Red: it’s the color of AIDS awareness. I continue to incorporate HIV into the creative work that I do.” When she looks back on her legacy, Lewis-Thornton says, “I’ll always be the first woman to tell my story on the cover of Essence magazine, to change the face of women with AIDS. I accepted that call. Once you have a call on your life, it never goes away. It’s there. So I’ll continue to do the work. God gave me a gift and I’ve been able to talk about my pain and adversity in a way that it enriches the lives of others. And I’m very humbled by that. I really am humbled to be at this place in history.” HIVPLUSMAG.COM | 47
B AC K TA L K B Y S AVA S A B A D S I D I S
calling out folks in power when they aren’t doing what they are supposed to be doing. Your essay about being raped was very powerful. How has that experience impacted your advocacy? The rape has made me protective of LGBT homeless youth, for every other reason I mentioned. It is especially Black and nonBlack people of color who are most at risk for homelessness, rape, and possibly HIV exposure. It has helped me in checking my own male privilege when women are sharing their rape stories, and helped me understand how to be supportive. There is nothing worse than being marginalized and trying to get someone to believe that you have had harm inflicted on our bodies. I hate injustice. Period. How long have you been an atheist? What does it mean to you? I have known since I was a teenager. The term “atheist” means that one has no belief system in relation to a god and religious systems. It is polarizing to some and liberating for others.
INTERSECTING JUSTICE THIS ACTIVIST SEES CONNECTIONS BETWEEN THE BLACK LIVES MATTER MOVEMENT, HIV ANTICRIMINALIZATION, HEALTH EDUCATION, AND ENDING TRANS DISCRIMINATION. AS H TO N P. WO O DS is a gay atheist who is also HIV-positive and “unapologetically” Black. None of the Houston-based activist’s multiple identities singularly define Woods, but rather serve as a reminder that being Black in America today isn’t a uniform experience. We pinned Woods down to discuss #BlackLivesMatter, atheism, rape, and so much more.
48 | JANUARY / FEBRUARY 2017
Where do you fall in the Black Lives Matter movement and how does your involvement dovetail with your other advocacy work? I fall into the movement as a leader in my own right. This is a movement that is leader-full. We all lead with our individual talents and traits. As an individual activist, the movement for Black lives is about a holistic approach to the decriminalization of blackness. This not just about police brutality, this is about total systemic change— change that improves lives through education about health, [both] physical and mental—and recognition of the intersections of gender identity and sexual orientation in our Black identity. One way I build on this movement to propel my own voice is via my blog, Strength in Numbers. Is HIV an important piece of the platform? This movement has and always will be led by women and queer-identified folks. These two groups are most affected by HIV and lack of access to sexual education, mental healthcare, and legal protections. The decriminalization of blackness means that we must also decriminalize HIV. We can see evidence that Black and brown folks are disproportionately affected by HIV. What’s life been like since joining Black Lives Matter? My experiences are always in flux. I feel as though I am always dealing with a wide range of emotions in every single moment that I live, [followed by] reflection, as well as constructing a positive and constructive way to respond. There are particulars, of course, including the homophobia and transphobia leveled toward my friends; and ever present are racism, sexism, and a host of other issues to overcome. I relish
How do you respond when people imply that lack of religion means the absence of ethical or moral values? It all depends on how folks bring the question of ethics and morality to me. I generally respond by saying that I was taught to know right from wrong. I even go as far as to question the motives of those who need a bible as guide to do the right thing. You don’t need the prospect of heaven or hell to do the right thing. Many in the civil rights movement were inspired by religion, but others also used the church to justify slavery. Do you find yourself in conflict with other members of the Black Lives Matter movement because of your beliefs? I think it should be noted that not everyone had religious beliefs in that era of the movement. The church was for the most part a “safe space” or neutral space where activists could meet and organize under the cover of “worship.” The church is definitely a tool of colonization for Black minds, but is now used to justify other forms of hate as well. As far as [Black Lives Matter] is concerned I wish people were more thoughtful about the fact that blackness is not a monolith. Not everyone is a Christian and there is a diaspora of religious belief systems, agnosticism, and of course, atheism. We must be all inclusive and respect all walks of life within the Black community. Where do you see yourself in the future? There is always work to be done as long as oppression is being taught … [and] when it comes to making sure the rights of others are not being violated. I see myself doing “the work” until the day I die. Through it all I will be vigilant and unapologetic about my blackness, gayness, and all of my other otherness.
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WHAT IT TRULY MEANS TO BE UNDETECTABLE BECAUSE YOU’RE MORE THAN YOUR STATUS
HAMILTON STAR JAVIER MUÑOZ COMES OUT POZ WHY MESS IS MUST SEE GAY TV RESISTANCE 101 HOW TO FIGHT OFF TREATMENT FAILURE
IT’S SAMPSON!
THE GAY COMIC GOES MANO-A-MANO WITH EMPIRE STAR JUSSIE SMOLLETT JANUARY/FEBRUARY 2017 www.hivplusmag.com